Denver Health & Hospitals, Denver, Colorado (K.M.).
Center for Health Progress, Denver, Colorado (J.S., C.K., J.N.).
Ann Intern Med. 2019 May 7;170(9_Suppl):S79-S86. doi: 10.7326/M18-2140.
Little is known about how to promote cost-of-care conversations in health care settings.
To develop and evaluate community-designed messages promoting cost-of-care conversations.
Focus groups and point-of-care surveys.
Three pediatric clinics, a family community health clinic, and a community health worker (promotora) program serving predominately low-income, Latino populations in Adams County, Colorado.
Focus groups included staff (n = 22) and patients or community members (n = 15). At baseline, 107 patients and 9 providers completed surveys, and 111 patients and 11 providers did so postintervention.
Setting-specific, community-designed messages about cost-of-care conversations delivered to patients on fliers.
Qualitative themes about the frequency and nature of cost-of-care conversations, and frequencies of patient- and provider-reported cost-of-care conversations before and after the intervention.
Five themes emerged from the focus groups, and the groups reported more discussion of costs after distribution of the messaging interventions than before in the clinical but not the community setting. Lack of transparent pricing tools was a barrier, and consideration of incidental costs was important. In cross-sectional, point-of-care surveys, fewer patients reported talking about costs with providers at baseline (44.4%) than after the messaging intervention (73.7%). Providers reported similar frequency of talking about costs with patients before (41.0%) and after (44.9%) the intervention. Nearly one third of patient and provider reports were discordant regarding whether costs were discussed.
The response rate was low, cost-of-care conversations were self-reported, generalizability of the findings to other settings is uncertain, and the sample was small. The survey proved infeasible in the promotora setting.
Participants reported some favorable perceptions of cost-of-care conversations after implementation of community-designed messages, suggesting promise for this approach to promoting conversations about costs of care in settings serving low-income, uninsured Latino populations.
Robert Wood Johnson Foundation.
对于如何在医疗环境中促进医疗费用的讨论，我们知之甚少。
开发并评估社区设计的促进医疗费用讨论的信息。
焦点小组和床边调查。
科罗拉多州亚当斯县的三家儿科诊所、一家家庭社区健康诊所和一个主要为低收入、拉丁裔人群服务的社区卫生工作者（ promotora ）项目。
焦点小组包括工作人员（n=22）和患者或社区成员（n=15）。基线时，107 名患者和 9 名提供者完成了调查，干预后 111 名患者和 11 名提供者完成了调查。
针对特定环境、社区设计的关于医疗费用讨论的信息，以传单的形式分发给患者。
关于医疗费用讨论的频率和性质的定性主题，以及干预前后患者和提供者报告的医疗费用讨论的频率。
焦点小组出现了五个主题，与干预前相比，在分发信息干预措施后，临床环境中讨论费用的频率更高，但在社区环境中没有。缺乏透明的定价工具是一个障碍，考虑意外成本很重要。在横断面、床边调查中，与提供者讨论费用的患者在基线时（44.4%）报告的比例低于干预后（73.7%）。提供者报告在干预前后与患者讨论费用的频率相似（41.0%和 44.9%）。近三分之一的患者和提供者报告在是否讨论费用方面存在不一致。
响应率低，医疗费用讨论是自我报告的，研究结果在其他环境中的推广性不确定，样本量小。该调查在 promotora 环境中不可行。
参与者在实施社区设计的信息后报告了对医疗费用讨论的一些有利看法，这表明这种方法有希望在为低收入、未保险的拉丁裔人群服务的环境中促进关于医疗费用的讨论。
罗伯特·伍德·约翰逊基金会。
