Cerier Emily, Beal Eliza W, Chakedis Jeffery, Chen Qinyu, Paredes Anghela, Sun Steven, Cloyd Jordan M, Pawlik Timothy M
Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
J Surg Res. 2018 Aug;228:290-298. doi: 10.1016/j.jss.2018.03.026. Epub 2018 Apr 14.
The patient-provider relationship (PPR) is an important element of health care delivery and may influence patient outcomes. The objective of the present study was to identify clinical predictors of PPR among patients with hepatopancreatobiliary (HPB) diseases and assess the association of PPR and health care utilization.
The Medical Expenditure Panel Survey database from 2008-2014 was used to identify adult patients with HPB diagnoses. A PPR score of "poor," "average," and "optimal" was calculated from the Consumer Assessment of Healthcare Providers and Systems Survey. Predictors of poor PPR and the association of PPR and health care utilization were assessed.
Among 592 patients, PPR was optimal (210, 35.4%), average (270, 45.5%), or poor (114, 19.2%). Patients without insurance (36.3%) or with Medicaid (28.8%) were more likely to report poor PPR versus patients with private insurance (14.0%) or Medicare (15.4%) (P = 0.03). Poor (24.3%)- and low (21.5%)-income patients were more likely to report poor PPR versus middle (12.8%)- or high-income (14.0%) patients (P = 0.03). Poor mental health was also more common among patients with poor PPR (13.4%) versus average (5.4%) or optimal (3.7%) PPR (P = 0.02), and this association between poor PPR and poor mental health remained significant on multivariable analysis (odds ratio [OR] 2.43, 95% confidence interval [CI] 1.20-4.92). Poor PPR was associated with increased emergency room utilization on univariate (OR 2.50, 95% CI 1.21-5.14), but not multivariate (OR 2.18, 95% CI 0.92-5.15) analysis.
Among patients with HPB diseases, PPR was associated with insurance type, socioeconomic status, and mental health scores. Patients reporting poor PPR were more likely to be high utilizers of the emergency room. Efforts to improve the PPR are needed and should be focused on these high-risk populations.
医患关系（PPR）是医疗服务提供的一个重要因素，可能会影响患者的治疗结果。本研究的目的是确定肝胰胆（HPB）疾病患者中PPR的临床预测因素，并评估PPR与医疗保健利用之间的关联。
使用2008 - 2014年医疗支出面板调查数据库来确定诊断为HPB的成年患者。根据医疗服务提供者和系统消费者评估调查计算出“差”“一般”和“最佳”的PPR评分。评估PPR差的预测因素以及PPR与医疗保健利用之间的关联。
在592名患者中，PPR为最佳（210例，35.4%）、一般（270例，45.5%）或差（114例，19.2%）。与有私人保险（14.0%）或医疗保险（15.4%）的患者相比，没有保险（36.3%）或有医疗补助（28.8%）的患者更有可能报告PPR差（P = 0.03）。与中等收入（12.8%）或高收入（14.0%）的患者相比，低收入（21.5%）和贫困（24.3%）患者更有可能报告PPR差（P = 0.03）。PPR差的患者中精神健康状况差也更常见（13.4%），而PPR一般（5.
