Assessing the Associations of Patient-Reported Perceptions of Patient-Centered Care as Supplemental Measures of Health Care Quality in VA.

BACKGROUND

Patient-reported experience measures (PREMs) are useful for assessing health care quality and safety and patients' perceptions of health care.

OBJECTIVE

We aimed to assess the relationship between PREMS [e.g., measures of patient-centered care (PCC)] and health care quality metrics.

DESIGN

We conducted a national survey via mail. Survey data were supplemented with US Department of Veteran Affairs (VA) administrative data.

PARTICIPANTS

Veteran (n = 5512) VA health care users participated in the study.

MAIN MEASURES

PCC measures included: patient activation; shared decision-making (SDM); empathy and holistic care; chronic illness care; perceptions of participation, respect for choices, and support; and overall health care experience. Health care quality measures included: preventive care screening receipt; chronic condition management (diabetes, hypertension); and health care utilization (hospitalizations, emergency room (ER) visits). Analyses included: bivariate comparisons of PCC measures by health care quality measures; and multivariate linear regression to identify variables associated with attaining multiple positive health care quality indicators (when controlling for potential confounders).

KEY RESULTS

PREMs assessing factors relating to patient-provider communication (e.g., empathic provider care, shared decision-making) are mainly related to clinical indicators representing good chronic condition management, while those relating more broadly to health care in general (e.g., patient activation, chronic illness care) are mainly related to measures of appropriate health care use (e.g., preventive care screening receipt; potentially avoidable hospitalizations; unscheduled care, such as ER visits). When controlling for potential confounders, higher perceptions of the decision-making effectiveness component of SDM (β = 0.004, p = 0.03) and empathy and holistic care (β = 0.01, p = 0.02) showed a weak but positive relationship with attaining a greater number of positive health care quality indicators, while a weak but negative relationship emerged for perceptions of participation, respect for choices, and support (β = -0.003, p = 0.03) and overall VA experiences (β = -0.10, p = 0.04).

CONCLUSIONS

PREMs that measure PCC offer rich data about health care quality while engaging patients, and considering patient experiences and preferences, in performance assessment. PREMs may be used to supplement existing performance metrics.