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Research ArticleOriginal Research

Patient-Centered Care is Associated with Decreased Health Care Utilization

Klea D. Bertakis and Rahman Azari
The Journal of the American Board of Family Medicine May 2011, 24 (3) 229-239; DOI: https://doi.org/10.3122/jabfm.2011.03.100170
Klea D. Bertakis
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Rahman Azari
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Article Figures & Data

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    Table 1.

    Individual Davis Observation Codes and Clusters

    Codes in Each ClusterAbbreviated Definitions of Codes
    Technical cluster
        Structuring interactionDiscussing what is to be accomplished in current interactions
        History takingPhysician inquiring about or patient describing details related to the current complaint or to prior illnesses
        Family informationDiscussing family, medical, or social history and/or current family functioning
        Physical examinationAny aspect of physical examination of patient
        Evaluation feedbackPhysician telling patient about results of history, physical, laboratory work, etc.
        Planning treatmentPhysician prescribing a medication, diagnostic, or treatment plan
        Treatment effectsPhysician inquiring about or patient describing result of ongoing therapeutic intervention
        ProcedureAny treatment or diagnostic procedure done in office
    Health behavior cluster
        ComplianceDiscussing previously requested behavior
        Health educationPhysician presenting information to patient regarding health
        Health promotionPhysician asking for change in patient’s behavior to increase or promote health
        NutritionAny question about or discussion about nutrition
        ExerciseAny question about or discussion about exercise
    Addiction cluster
        Substance useAny question about or discussion of drinking alcohol or use of other substances
        Smoking behaviorAny question about or discussion of smoking or use of tobacco
    Patient activation cluster
        Health knowledgePhysician asking or patient spontaneously offering what patient knows or believes about health and disease
        Patient questionPatient asking question
        ChattingDiscussing topics not related to current visit
    Preventive service cluster
        Preventive servicePhysician discussing, planning, or performing any screening task for disease prevention
    Counseling Cluster
        CounselingPhysician discussing interpersonal relations or current emotional state of patient or patient’s family
    • Those Davis Observation Codes in bold print are included in the modified version of DOC, which measures Patient-Centered Care.

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    Table 2.

    Sociodemographic and Health Data for All Study Patients (n = 509) and Patients with Yearling Patient-Centered Care Below (n = 254) and Greater than or Equal to (n = 255) the Median

    All Patients (n = 509)<Median (n = 254)≥Median (n = 255)
    Sex (%)
        Male38.1139.3736.86
        Female61.8960.6361.14
    Age (mean years [SD])41.74 (14.73)42.24 (14.30)41.24 (15.15)
    Education (mean years [SD])12.61 (2.73)12.32 (2.59)12.89 (2.85)
    Income* (%)
        <$10,00049.1155.5642.69
        $10,000–$19,99924.7524.6024.90
        $20,000–$29,99910.5010.3210.67
        $30,000–$39,9996.142.389.88
        $40,000–$49,9994.163.974.35
        ≥$50,0005.353.177.51
    Physical health status† (n [mean])40.44 (11.88)39.01 (12.07)41.87 (11.53)
    Mental health status† (n [mean])43.99 (12.55)43.92 (12.36)44.05 (12.76)
    BMI (mean)29.76 (8.39)29.19 (7.85)30.33 (8.87)
    Alcohol abuse (%)7.699.845.53
    Smoker (%)67.8574.4161.26
    • ↵* Income data was available for 505 study patients.

    • ↵† Physical health status and mental health status were measured by the physical and mental components of the Medical Outcomes Study Short Form-36. The established means for these are 50 (SD, 10). BMI, body mass index.

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    Table 3.

    Descriptive Statistics for Medical Resource Use and Charges (n = 509)

    Below Median Patient-Centered Care (n = 254)Equal or Above Median Patient-Centered Care (n = 255)
    Mean (SD)Median (Range)Mean (SD)Median (Range)
    Type of visits
    Primary care3.64 (2.94)3.00 (1–24.00)3.66 (3.38)3.00 (1–24.00)
    Specialty care2.94 (4.50)1.00 (0–26.00)2.22 (4.06)0.00 (0–21.00)
    Emergency department0.35 (0.98)0.00 (0–8.00)0.22 (0.65)0.00 (0–4.00)
    Hospitalizations0.25 (0.75)0.00 (0–6.00)0.11 (0.42)0.00 (0–3.00)
    Diagnostic services10.42 (11.86)7.00 (0–90.00)7.42 (9.63)5.00 (0–89.00)
    Type of charges ($)
    Primary care338.18 (267.00)274.00 (0–1,893.10)322.34 (312.37)222.50 (0–2,017.00)
    Specialty care646.37 (1,758.88)128.00 (0–16,528.10)329.41 (746.67)0.00 (0–6,168.00)
    Emergency department550.93 (1,913.96)0.00 (0–18,782.50)256.35 (846.09)0.00 (0–6,596.50)
    Hospitalizations5,360.35 (22,566.23)0.00 (0–194,958.50)2,547.00 (11,266.65)0.00 (0–123,446.00)
    Diagnostic services1,413.30 (2,311.54)532.00 (0–23,190.50)886.30 (1,368.26)390.50 (0–10,645.50)
    Total charges8,308.32 (24,811.19)1,435.00 (49.5–203,234.50)4,341.40 (12,575.57)948.00 (0–134,788.50)
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    Table 4.

    Two-Part Regression Models for Utilization of Specialty Care Clinic and Charges Using Patient-Centeredness, Sex, Age, Education, Income, Obesity, Smoking, Alcohol Abuse, Mental and Physical Health Status as Explanatory Variables

    Dependent VariableIndependent Variable*Utilization†Charges‡
    Odds Ratio (95% CI)PSEPR2
    Specialty Care Clinic (n = 260)Female sex1.636 (1.083–2.471).0192−0.0127.84270.1086
    Age1.026 (1.012–1.040).00030.1168.0653
    Education1.005 (0.933–1.082).8972−0.0052.9348
    Income1.020 (0.947–1.099).59440.0223.7376
    Obesity1.705 (1.157–2.514).0070−0.0360.5592
    Smoking1.153 (0.756–1.757).50880.0187.7684
    Alcohol abuse2.210 (1.041–4.692).0391−0.0533.3932
    Mental health status1.010 (0.994–1.026).22850.0810.1962
    Physical health status0.979 (0.963–0.996).0154−0.1423.0266
    Patient-centered care0.966 (0.934–0.999).0417−0.2239.0005
    • ↵* All independent variables are baseline measurements except for the patient centered care, which is averaged over 1 year of care.

    • ↵† Utilization results were obtained by logistic regression models.

    • ↵‡ Medical charges for specialty care are in log-transformed dollars, with mean 6.04 (SD, 1.24).

    • SE, standardized error.

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    Table 5.

    Standardized Estimates from Regression Equations in Which Total Medical Charges* are Explained by the Average Percentage of Patient-Centered Care Over the 1-Year Study Period, Controlling for Baseline Patient Sex, Age, Education, Income, Physical Health Status, Mental Health Status, Obesity, Alcohol Abuse, and Smoking (n = 494)

    Dependent VariableIndependent Variables†SEPR2
    Total charges (primary, specialty, and emergency care, hospitalizations and diagnostic services)Female sex0.1098.01150.2142
    Age0.2332<.0001
    Education−0.0121.7803
    Income−0.0119.7878
    Physical health status−0.2327<.0001
    Mental health status0.0023.9564
    Obesity0.0806.0511
    Alcohol abuse0.0405.3317
    Smoking0.0773.0701
    Patient-centered care−0.1575.0002
    • ↵* Total Medical Charges with mean 7.22 (SD = 1.59).

    • ↵† All independent variables are baseline measurements, except for the patient centered care which is averaged over one year of care.

    • SE, standardized error.

    • View popup
    Table 6.

    Standardized Estimates from Regression Equations in which Total Medical Charges* are Explained by the Average Percentage of Patient-Centered Care Over the 1-Year Study Period, for Female Compared to Male Patients Controlling for Baseline Patient Age, Education, Income, Physical Health Status, Mental Health Status, Obesity, Alcohol Abuse, and Smoking

    Independent Variable†Women (n = 306)Men (n = 188)
    SEPR2SEPR2
    Age0.2339<.00010.15470.2530.00020.3118
    Education0.0351.5370−0.0672.3248
    Income−0.0684.24120.0781.2535
    Physical health status−0.1647.0043−0.3460<.0001
    Mental health status0.0178.7480−0.0263.6822
    Obesity0.0764.16220.0791.2223
    Alcohol abuse0.0029.95830.0621.3356
    Smoking0.0838.14530.0896.1707
    Patient-centered care−0.1292.0255−0.1889.0045
    • ↵* Total medical charges are in log-transformed dollars, with mean 7.37 (SD, 1.51) for women and 6.97 (SD, 1.68) for men.

    • ↵† All independent variables are baseline measurements except for the patient centered care, which is averaged over 1 year of care.

    • SE, standardized error.

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The Journal of the American Board of Family Medicine: 24 (3)
The Journal of the American Board of Family Medicine
Vol. 24, Issue 3
May-June 2011
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Patient-Centered Care is Associated with Decreased Health Care Utilization
Klea D. Bertakis, Rahman Azari
The Journal of the American Board of Family Medicine May 2011, 24 (3) 229-239; DOI: 10.3122/jabfm.2011.03.100170

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Patient-Centered Care is Associated with Decreased Health Care Utilization
Klea D. Bertakis, Rahman Azari
The Journal of the American Board of Family Medicine May 2011, 24 (3) 229-239; DOI: 10.3122/jabfm.2011.03.100170
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