Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA.
Center for Healthcare Advancement and Outcomes, Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA.
J Gastrointest Surg. 2018 Apr;22(4):624-632. doi: 10.1007/s11605-017-3610-z. Epub 2017 Nov 20.
Patient-provider communication (PPC) is utilized as a value-based metric in pay-for-performance programs. We sought to evaluate the association of PPC with patient-reported health outcomes, as well as healthcare resource utilization among a nationally representative cohort of patients with hepato-pancreato-biliary (HPB) diagnoses.
Patients with HPB diseases were identified from the 2008-2014 Medical Expenditure Panel Survey cohort. A weighted PPC composite score was categorized using the responses from the CAHPS (Consumer Assessment of Healthcare Providers and Systems) survey as optimal, average, or poor. Multivariate analysis was performed using logistic regression.
Among 1951 adult-patients, representing 21.7 million HPB patients, reported PPC was optimal (33.4%), average (46.3%), or poor (15.3%). Patients who were older and patients with low income were more likely to report poor PPC (both p < 0.05). Statin use, a quality of care measure, was associated with optimal PPC (OR 1.70, 95% CI 1.10-2.64; p = 0.01). In contrast, patients who reported poor PPC were more likely to have a poor physical (20.8%) or mental (8.8%) health component on their SF12 (both p < 0.05). Furthermore, patients with poor PPC were more likely to report poor mental status (OR 2.97, 95% CI 1.60-5.52), as well as higher emergency department visits (OR 1.95, 95% CI 1.25-3.05) and hospitalizations (OR 1.90, 95% CI 1.02-3.55) (both p < 0.05). Reported PPC was not associated with differences in overall healthcare expenditures or out-of-pocket expenditures.
PPC was associated with a wide spectrum of patient-specific demographic and health utilization factors. Self-reported patient satisfaction with provider communication may be impacted by other considerations than simply the patient-provider interaction.
医患沟通（PPC）在按绩效付费计划中被用作基于价值的指标。我们试图评估 PPC 与患者报告的健康结果以及具有肝胆胰（HPB）诊断的全国代表性患者队列的医疗资源利用之间的关联。
从 2008-2014 年医疗支出面板调查队列中确定了患有 HPB 疾病的患者。使用 CAHPS（医疗保健提供者和系统消费者评估）调查的答复将加权 PPC 综合评分归类为最佳、平均或较差。使用逻辑回归进行多变量分析。
在 1951 名成年患者中，代表 2170 万 HPB 患者，报告的 PPC 为最佳（33.4%）、平均（46.3%）或较差（15.3%）。年龄较大和收入较低的患者更有可能报告较差的 PPC（均 p < 0.05）。他汀类药物的使用，一种质量护理措施，与最佳 PPC 相关（OR 1.70，95%CI 1.10-2.64；p = 0.01）。相比之下，报告 PPC 较差的患者更有可能在 SF12 上报告较差的身体（20.8%）或精神（8.8%）健康成分（均 p < 0.05）。此外，报告 PPC 较差的患者更有可能报告较差的精神状态（OR 2.97，95%CI 1.60-5.52），以及更高的急诊就诊次数（OR 1.95，95%CI 1.25-3.05）和住院治疗（OR 1.90，95%CI 1.02-3.55）（均 p < 0.05）。报告的 PPC 与总体医疗支出或自付支出无差异。
PPC 与广泛的患者特定人口统计学和健康利用因素相关。患者对提供者沟通的自我报告满意度可能受到除患者-提供者互动之外的其他因素的影响。
