Department of Social and Behavioral Sciences, School of Global Public Health, New York University.
Department of Population Health, Grossman School of Medicine, New York University, New York, NY.
Med Care. 2022 May 1;60(5):324-331. doi: 10.1097/MLR.0000000000001694.
Effective patient-provider communication (PPC) can improve clinical outcomes and therapeutic alliance. While PPC may have improved over time due to the implementation of various policies for patient-centered care, its nationwide trend remains unclear.
The objective of this study was to examine trends in PPC quality among US adults and whether trends vary with race-ethnicity.
A repeated cross-sectional study.
We examine noninstitutionalized civilian adults who made 1 or more health care visits in the last 12 months and self-completed the mail-back questionnaire in the Medical Expenditure Panel Survey, 2002-2016.
Outcomes include 4 top-box measures, each representing the odds of patients reporting that their providers always (vs. never, sometimes, usually) used a given communication behavior in the past 12 months regarding listening carefully, explaining things understandably, showing respect, and spending enough time. A linear mean composite score (the average of ordinal responses for the behaviors above) is also examined as an outcome. Exposures include time period and race-ethnicity.
Among 124,158 adults (181,864 observations), the quality of PPC increases monotonically between 2002 and 2016 for all outcomes. Between the first and last periods, the odds of high-quality PPC increase by 37% [95% confidence interval (CI)=32%-43%] for listen, 25% (95% CI=20%-30%) for explain, 41% (95% CI=35%-47%) for respect, and 37% (95% CI=31%-43%) for time. The composite score increases by 3.24 (95% CI=2.87-3.60) points. While increasing trends are found among all racial groups, differences exist at each period. Asians report the lowest quality throughout the study period for all outcomes, while Blacks report the highest quality. Although racial differences narrow over time, most changes are not significant.
Our findings suggest that providers are increasingly likely to use patient-centered communication strategies. While racial differences have narrowed, Asians report the lowest quality throughout the study period, warranting future research.
有效的医患沟通（PPC）可以改善临床结果和治疗联盟。尽管由于实施了各种以患者为中心的护理政策，PPC 可能随着时间的推移而有所改善，但它在全国范围内的趋势尚不清楚。
本研究旨在探讨美国成年人中 PPC 质量的趋势，以及这种趋势是否因种族和民族而异。
重复横断面研究。
我们检查了在过去 12 个月内进行过 1 次或多次医疗保健就诊且在医疗支出面板调查中通过邮件回复问卷的非机构化平民成年人，2002-2016 年。
结果包括 4 个顶盒指标，每个指标代表患者报告其提供者在过去 12 个月中始终（而非偶尔、通常）使用给定沟通行为的可能性，这些行为涉及仔细倾听、清晰解释、表示尊重和花费足够的时间。还检查了线性平均综合评分（上述行为的序数反应平均值）作为结果。暴露因素包括时间段和种族。
在 124158 名成年人（181864 次观察）中，所有结果的 PPC 质量在 2002 年至 2016 年间呈单调递增趋势。在第一期和最后一期之间，高质量 PPC 的可能性增加了 37%[95%置信区间（CI）=32%-43%]，倾听增加了 25%（95%CI=20%-30%），尊重增加了 41%（95%CI=35%-47%），时间增加了 37%（95%CI=31%-43%）。综合评分增加了 3.24（95%CI=2.87-3.60）点。虽然在所有种族群体中都发现了上升趋势，但在每个时期都存在差异。在整个研究期间，亚洲人报告的所有结果的质量最低，而黑人报告的质量最高。尽管种族差异随着时间的推移而缩小，但大多数变化并不显著。
我们的研究结果表明，提供者越来越有可能使用以患者为中心的沟通策略。虽然种族差异有所缩小，但在整个研究期间，亚洲人报告的质量最低，这需要进一步研究。
