Chapter 5. Patient Centeredness

Patient centeredness is defined as:

[H]ealth care that establishes a partnership among practitioners, patients, and their families (when appropriate) to ensure that decisions respect patients' wants, needs, and preferences and that patients have the education and support they need to make decisions and participate in their own care.¹

An important dimension of quality, patient centeredness "encompasses qualities of compassion, empathy, and responsiveness to the needs, values, and expressed preferences of the individual patient."²

Importance

Morbidity and Mortality

• Patient-centered approaches to care have been shown to improve patients' health status. These approaches rely on building a provider-patient relationship, improving communication, fostering a positive atmosphere, and encouraging patients to actively participate in patient-provider interactions.^3,4
• A patient-centered approach has been shown to lessen patients' symptom burden.⁵
• Patient-centered care encourages patients to comply with treatment regimens.⁶

Patient-centered care can reduce the chance of misdiagnosis due to poor communication.⁷

Cost

• Patient centeredness has been shown to reduce underuse and overuse of medical services.⁸
• Patient centeredness can reduce the strain on system resources and save money by reducing the number of diagnostic tests and referrals.⁵
• Although some studies have shown that being patient centered reduces costs and use of health service resources, others have shown that patient centeredness increases providers' costs, especially in the short run.⁹

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Measures

The National Healthcare Quality Report tracks four measures of patients' experience of care. The core report measure is a composite of these measures-patients' assessments of how often their provider listened carefully to them, explained things clearly, respected what they had to say, and spent enough time with them.

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Findings

Patients' Experience of Care—Adults

Optimal health care requires good communication between patients and providers, yet barriers to patient-provider communication are common. To provide all patients with the best possible care, providers must be able to understand patients' diverse health care needs and preferences and communicate clearly with patients about their care.

Figure 5.1. Composite measure: Adult ambulatory patients who reported poor communication with health providers,^* by age group, 2000-2005

^* Average percentage of adults who had a doctor's office or clinic visit in the last 12 months and reported poor communication with health providers (i.e., that their health providers sometimes or never listened carefully, explained things clearly, showed respect for what they had to say, and spent enough time with them).

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2000-2005.
Denominator: Civilian noninstitutionalized population age 18 and over who visited a doctor's office or clinic to get health care in the last 12 months.

• In 2005, 9.7% of adults who had a doctor's office or clinic visit in the last 12 months reported poor communication (Figure 5.1).
• Between 2000 and 2005, the average percentage of adults with a doctor's office or clinic visit who reported poor communication decreased for the total population from 11.2% to 9.7%. Most of this improvement occurred between 2002 and 2003.
• Improvements were also seen from 2000 to 2005 for adults ages 45-64. There was no significant change in the percentages for adults ages 18-44 or 65 and over.
• In all 6 data years, the average percentage of adults with doctor's office or clinic visits who reported poor communication was lowest among adults age 65 and over.

Figure 5.2. State variation: Adult ambulatory patients who reported good communication with health providers,^* 2007

^*Average percentage of adults who had a doctor's office or clinic visit in the last 12 months and reported good communication with health providers (i.e., that their health providers always listened carefully, explained things clearly, showed respect for what they had to say, and spent enough time with them).
Key: Higher rate = rate is significantly above the all States average in 2007. Lower rate = rate is significantly below the all States average in 2007.
Source: Agency for Healthcare Research and Quality, National CAHPS® Benchmarking Database, 2007.
Denominator: Adults with Medicare fee-for-service benefits who visited a doctor's office or clinic in the past 12 months.
Note: "All States average" is the average of all responding States (44 in this case, including the District of Columbia and Puerto Rico), which is a separate figure from the national average.

• In 2007, individual State scores for this composite measureⁱ of communication with health providers ranged from a low (i.e., worse communication) of 70.6% to a high of 81.7%.
• In 2007, two Statesⁱⁱ and Puerto Rico were above (i.e., better communication) the all States average of 70.6% for this composite measure of communication with health providers (Figure 5.2).
• Two Statesⁱⁱⁱ were below (i.e., worse communication) the all States average for this measure in 2007.

Patients' Experience of Care—Children

Communication in children's health care can pose a particular challenge as children are often less able to express their health care needs and preferences, and a third party (e.g., a parent or guardian) is involved in communication and decisionmaking. Optimal communication in children's health care can therefore have a significant impact on receipt of high-quality care and subsequent health status.

Figure 5.3. Composite measure: Children with ambulatory visits whose parents reported poor communication with health providers,^* 2001-2005

^* Average percentage of children who had a doctor's office or clinic visit in the last 12 months and were reported to have had poor communication with health providers (i.e., that their health providers sometimes or never listened carefully, explained things clearly, showed respect for what they had to say, and spent enough time with them).
Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2001-2005.
Denominator: Civilian noninstitutionalized population under age 18 who visited a doctor's office or clinic to get heath care in the last 12 months.
Note: Additional age subgroups of 01, 2-5, 6-11, and 12-17 were reviewed but did not have any statistically significant differences.

• In 2005, 5.5% of parents of children who had a doctor's office or clinic visit in the last 12 months reported poor communication with health providers. This rate is a significant improvement over the 2001 rate of 7.0% (Figure 5.3).
• This improvement since 2001 was true for children under age 6, as well as those ages 6-17.

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ⁱ Note that respondents were asked to choose "sometimes," "never," "usually," or "always." In contrast to Figure 5.1, the map shown in Figure 5.2 displays results for respondents answering "always."
ⁱⁱ The States were Rhode Island and West Virginia.
ⁱⁱⁱ The States were Arizona and California.

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References

1. Institute of Medicine. Envisioning the national health care quality report. Washington, DC: National Academy Press; 2001.

2. Institute of Medicine. Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy Press; 2001.

3. Stewart M, Brown JB, Donner A, et al. The impact of patient-centered care on outcomes. J Fam Pract 2000 Sep;49(9):796-804.

4. Anderson EB. Patient-centeredness: a new approach. Nephrol News Issues 2002 Nov;16(12):80-82.

5. Little P, Everitt H, Williamson I, et al. Observational study of effect of patient centeredness and positive approach on outcomes of general practice consultations. BMJ 2001 Oct 20;323(7318):908-11.

6. Beck R, Daughtridge R, Sloane PD. Physician-patient communication in the primary care office: a systematic review. J Am Board Fam Pract 2002 Jan-Feb;15(1):25-38.

7. DiMatteo M. The role of the physician in the emerging health care environment. West J Med 1998 May;168(5):328-33.

8. Berry L, Seiders K, Wilder SS. Innovations in access to care: a patient-centered approach. Ann Intern Med 2003 Oct 7;139(7):568-74.

9. Bechel D, Myers WA, Smith DG. Does patient-centered care pay off? Jt Comm J Qual Improv 2000;26(7):400-9.

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