Zaidi Syeda Hina, Axon David Rhys
Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, 1295 North Martin Avenue, P.O. Box 210202, Tucson, AZ 85721, USA.
Healthcare (Basel). 2024 Aug 27;12(17):1709. doi: 10.3390/healthcare12171709.
Shared decision-making (SDM) is an essential component of patient-centered healthcare and disease management. However, the association of SDM with healthcare resource utilization and patient-reported outcomes among multimorbid individuals is not well understood. This study sought to evaluate the association of SDM with healthcare resource utilization and patient-reported outcomes among United States (US) adults with multimorbidity. Data were collected from the 2020 Medical Expenditure Panel Survey (MEPS) for this cross-sectional study. Eligible participants were US adults with two or more comorbidities. The predictor variable was SDM (optimal versus not optimal). The outcome variables were healthcare resource utilization and patient-reported outcomes. Logistic regression models, adjusted for demographic characteristics, assessed associations with SDM for each healthcare resource utilization and patient-reported outcome variable. The analysis maintained the complex survey data and was weighted to produce nationally representative estimates. Individuals who reported optimal SDM in adjusted analyses utilized more healthcare resources compared to those who reported not optimal SDM. Individuals with optimal SDM had more than one outpatient visit (odds ratio OR = 1.23, 95% CI = 1.03-1.47), emergency room visit (OR = 1.55, 95% CI = 1.17-2.06), and inpatient discharge (OR = 1.44, 95% CI = 1.05-1.96). Additionally, these individuals had higher odds of reporting limitations in their ability to work or engage in other activities due to their physical health in the past four weeks (OR = 1.27, 95% CI = 1.01-1.60). This study indicated evidence of increased healthcare resource utilization among patients who participate in SDM with their providers, which should be explored in future studies.
共同决策（SDM）是以患者为中心的医疗保健和疾病管理的重要组成部分。然而，在患有多种疾病的个体中，SDM与医疗资源利用及患者报告的结局之间的关联尚未得到充分理解。本研究旨在评估美国患有多种疾病的成年人中，SDM与医疗资源利用及患者报告的结局之间的关联。本横断面研究的数据来自2020年医疗支出面板调查（MEPS）。符合条件的参与者为患有两种或更多种合并症的美国成年人。预测变量为SDM（最佳与非最佳）。结局变量为医疗资源利用和患者报告的结局。经人口统计学特征调整的逻辑回归模型评估了每种医疗资源利用和患者报告结局变量与SDM的关联。分析保留了复杂的调查数据并进行加权，以得出具有全国代表性的估计值。在调整分析中报告最佳SDM的个体与报告非最佳SDM的个体相比，使用了更多的医疗资源。具有最佳SDM的个体进行了不止一次门诊就诊（优势比OR = 1.23，95%置信区间CI = 1.03 - 1.47）、急诊就诊（OR = 1.55，95%CI = 1.17 - 2.06）和住院出院（OR = 1.44，95%CI = 1.05 - 1.96）。此外，在过去四周内，这些个体因身体健康而报告工作或参与其他活动能力受限的几率更高（OR = 1.27，95%CI = 1.01 - 1.60）。本研究表明，与提供者参与SDM的患者中医疗资源利用增加的证据，这应在未来研究中进行探讨。
