Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Mossavar-Rahmani Center for Business and Government, Harvard Kennedy School, Cambridge, Massachusetts.
JAMA Netw Open. 2019 Aug 2;2(8):e1910399. doi: 10.1001/jamanetworkopen.2019.10399.
Quantifying patient-physician cost conversations is challenging but important as out-of-pocket spending by US patients increases and patients are increasingly interested in discussing costs with their physicians.
To characterize the prevalence of financial considerations documented in narrative clinical records of primary care encounters and their association with patient-level features.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study applied natural language processing to narrative clinical notes obtained from electronic health records for adult primary care visits. Participants included patients aged 18 years and older with at least 1 primary care visit for an annual preventive examination at outpatient clinics at a US academic health system between January 2, 2008, and July 30, 2013. Data were analyzed in March 2019.
Presence of financial content documented in narrative clinical notes.
The data set included 222 457 primary care visits for 46 244 individuals aged 18 years and older; 30 556 patients (60.1%) were female, 27 869 patients (60.3%) were white, and the mean (SD) age was 51.3 (17.7) years. In total, 6058 patients (13.1%) had at least 1 narrative clinical note indicating a financial conversation with their physician. In fully adjusted regression models, the odds of having a financial note were greater among patients with Medicare (odds ratio [OR], 1.27; 95% CI, 1.15-1.41; P < .001) or Medicaid (OR, 1.43; 95% CI, 1.25-1.64; P < .001) insurance, those residing in zip codes with lower median income (OR, 0.97; 95% CI, 0.96-0.98; P < .001), black individuals (OR, 1.40; 95% CI, 1.28-1.53; P < .001), Hispanic individuals (OR, 1.10; 95% CI, 1.01-1.20; P = .03), and those who were unmarried (OR, 1.23; 95% CI, 1.15-1.33; P < .001).
Cost considerations were more likely to be noted in annual preventive examinations than previously observed in intensive care unit admissions, but still infrequently. Associations with particular patient subgroups may indicate differential financial burden or willingness to discuss financial concerns.
随着美国患者自付费用的增加，以及患者越来越有兴趣与医生讨论费用问题，量化医患之间的成本对话变得具有挑战性，但也很重要。
描述初级保健就诊的叙事临床记录中记录的财务考虑因素的普遍程度及其与患者特征的关联。
设计、地点和参与者：本队列研究应用自然语言处理技术从美国学术健康系统门诊进行的年度预防检查的成年初级保健就诊的电子健康记录中获取的叙述性临床记录。参与者包括 2008 年 1 月 2 日至 2013 年 7 月 30 日期间至少有一次初级保健就诊的 18 岁及以上患者。数据于 2019 年 3 月进行分析。
在叙述性临床记录中记录财务内容的存在。
该数据集包括 222457 次初级保健就诊，涉及 46244 名 18 岁及以上的个体；30556 名患者（60.1%）为女性，27869 名患者（60.3%）为白人，平均（SD）年龄为 51.3（17.7）岁。共有 6058 名患者（13.1%）至少有 1 份叙述性临床记录表明与医生进行了财务对话。在完全调整的回归模型中，具有医疗保险（优势比[OR]，1.27；95%置信区间[CI]，1.15-1.41；P < .001）或医疗补助（OR，1.43；95% CI，1.25-1.64；P < .001）保险、居住在中等收入中位数较低的邮政编码（OR，0.97；95% CI，0.96-0.98；P < .001）、黑人（OR，1.40；95% CI，1.28-1.53；P < .001）、西班牙裔（OR，1.10；95% CI，1.01-1.20；P = .03）和未婚者（OR，1.23；95% CI，1.15-1.33；P < .001）的患者更有可能记录成本考虑因素。
与之前在重症监护病房入院中观察到的情况相比，在年度预防检查中更有可能记录费用考虑因素，但仍然很少见。与特定患者亚组的关联可能表明存在不同的经济负担或愿意讨论经济问题。
