Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, MN 55905. Email:
Am J Manag Care. 2020 Oct;26(10):425-430. doi: 10.37765/ajmc.2020.88500.
To measure the impact of patient-centered communication on mortality and hospitalization among patients with heart failure (HF).
This was a survey study of 6208 residents of 11 counties in southeast Minnesota with incident HF (first-ever International Classification of Diseases, Ninth Revision code 428 or International Classification of Diseases, Tenth Revision code I50) between January 1, 2013, and March 31, 2016.
Perceived patient-centered communication was assessed with the health care subscale of the Chronic Illness Resources Survey and measured as a composite score on three 5-point scales. We divided our cohort into tertiles and defined them as having fair/poor (score < 12), good (score of 12 or 13), and excellent (score ≥ 14) patient-centered communication. The survey was returned by 2868 participants (response rate: 45%), and those with complete data were retained for analysis (N = 2398). Cox and Andersen-Gill models were used to determine the association of patient-centered communication with death and hospitalization, respectively.
Among 2398 participants (median age, 75 years; 54% men), 233 deaths and 1194 hospitalizations occurred after a mean (SD) follow-up of 1.3 (0.6) years. Compared with patients with fair/poor patient-centered communication, those with good (HR, 0.70; 95% CI, 0.51-0.97) and excellent (HR, 0.70; 95% CI, 0.51-0.96) patient-centered communication experienced lower risks of death after adjustment for various confounders (Ptrend = .020). Patient-centered communication was not associated with hospitalization.
Among community patients living with HF, excellent and good patient-centered communication is associated with a reduced risk of death. Patient-centered communication can be easily assessed, and consideration should be given toward implementation in clinical practice.
测量以患者为中心的沟通对心力衰竭（HF）患者的死亡率和住院率的影响。
这是一项对 2013 年 1 月 1 日至 2016 年 3 月 31 日期间明尼苏达州东南部 11 个县的 6208 名新发心力衰竭患者（首次国际疾病分类，第九版代码 428 或国际疾病分类，第十版代码 I50）的调查研究。
使用慢性病资源调查的医疗保健子量表评估感知到的以患者为中心的沟通，并将其测量为三个 5 分制量表的综合得分。我们将队列分为三分位数，并将其定义为沟通效果一般/较差（得分<12）、良好（得分 12 或 13）和优秀（得分≥14）。共有 2868 名参与者（应答率：45%）回复了调查，其中数据完整的参与者被保留用于分析（n=2398）。Cox 和 Andersen-Gill 模型分别用于确定以患者为中心的沟通与死亡和住院的关联。
在 2398 名参与者中（中位年龄 75 岁，54%为男性），平均（标准差）随访 1.3（0.6）年后发生了 233 例死亡和 1194 例住院治疗。与沟通效果一般/较差的患者相比，沟通效果良好（HR，0.70；95%CI，0.51-0.97）和优秀（HR，0.70；95%CI，0.51-0.96）的患者死亡风险较低，调整了各种混杂因素后（Ptrend=.020）。以患者为中心的沟通与住院无关。
在社区心力衰竭患者中，优秀和良好的以患者为中心的沟通与降低死亡风险相关。以患者为中心的沟通可以很容易地评估，应考虑在临床实践中实施。
