University of Illinois at Chicago, 2730 UH MC 103, 601 South Morgan, Chicago, IL 60607-7128, USA.
Ann Intern Med. 2013 Apr 16;158(8):573-9. doi: 10.7326/0003-4819-158-8-201304160-00001.
Patient-centered decision making (PCDM) is the process of identifying clinically relevant, patient-specific circumstances and behaviors to formulate a contextually appropriate care plan.
To ascertain whether encounters in which PCDM occurs are followed by improved health care outcomes compared with encounters where there is inattention to patient context.
Patients surreptitiously audio-recorded encounters with their physicians. Medical records of these encounters were then screened for "contextual red flags," such as deteriorating self-management of a chronic condition, that could reflect such underlying contextual factors as competing responsibilities or loss of social support. When a contextual factor was identified, either as a result of physician questioning or because a patient volunteered information, physicians were scored on the basis of whether they adapted the care plan to it.
Internal medicine clinics at 2 Veterans Affairs facilities.
774 patients audio-recorded encounters with 139 resident physicians.
Individualized outcome measures were based on the contextual red flag, such as improved blood pressure control in a patient presenting with hypertension and loss of medication coverage. Outcome coders were blinded to physician performance.
Among 548 contextual red flags, 208 contextual factors were confirmed, either when physicians probed or patients volunteered information. Physician attention to contextual factors (both probing for them and addressing them in care plans) varied according to the presenting contextual red flags. Outcome data were available for 157 contextual factors, of which PCDM was found to address 96. Of these, health care outcomes improved in 68 (71%), compared with 28 (46%) of the 61 that were not addressed by PCDM (P = 0.002).
The extent to which the findings can be generalized to other clinical settings is unknown.
Attention to patient needs and circumstances when planning care is associated with improved health care outcomes.
U.S. Department of Veterans Affairs, Health Services Research & Development Service.
以患者为中心的决策制定（PCDM）是一个识别临床相关、患者特定情况和行为，以制定上下文适当的护理计划的过程。
确定在发生 PCDM 的情况下，与不关注患者背景的情况下相比，医疗保健结果是否得到改善。
患者秘密地录制与医生的会面。然后筛选这些会面的医疗记录，以寻找“背景红旗”，例如慢性疾病自我管理恶化，这可能反映出竞争责任或失去社会支持等潜在的背景因素。当确定了一个背景因素时，无论是由于医生提问还是因为患者自愿提供信息，都会根据医生是否根据该因素调整护理计划对医生进行评分。
两个退伍军人事务设施的内科诊所。
774 名患者录制了与 139 名住院医生的会面。
个体化的结果测量基于背景红旗，例如高血压患者的血压控制改善和药物覆盖丧失。结果编码员对医生的表现一无所知。
在 548 个背景红旗中，有 208 个背景因素得到了证实，无论是医生提问还是患者自愿提供信息。医生对背景因素的关注（包括对其进行调查和在护理计划中解决）因呈现的背景红旗而异。有 157 个背景因素的结果数据可用，其中发现 PCDM 解决了 96 个。在这些中，有 68 个（71%）的医疗保健结果得到了改善，而没有通过 PCDM 解决的 61 个（46%）则没有改善（P=0.002）。
这些发现可以推广到其他临床环境的程度尚不清楚。
在规划护理时关注患者的需求和情况与改善医疗保健结果相关。
美国退伍军人事务部，卫生服务研究与发展服务。
