Abstract
PURPOSE: Although patient-centered communication is associated with improved health and patient trust, information about the impact of patient-centered communication on health care costs is limited. We studied the relationship between patient-centered communication and diagnostic testing expenditures. METHODS: We undertook an observational cross-sectional study using covert standardized patient visits to study physician interaction style and its relationship to diagnostic testing costs. Participants were 100 primary care physicians in the Rochester, NY, area participating in a large managed care organization (MCO). Audio recordings of 2 standardized patient encounters for each physician were rated using the Measure of Patient-Centered Communication (MPCC). Standardized diagnostic testing and other expenditures, adjusted for patient demographics and case-mix, were derived from the MCO claims database. Analyses were adjusted for demographics and standardized patient detection. RESULTS: Compared with other physicians, those who had MPCC scores in the lowest tercile had greater standardized diagnostic testing expenditures (11.0% higher, 95% confidence interval [CI], 4.5%-17.8%) and greater total standardized expenditures (3.5% higher, 95% CI, 1.0%-6.1%). Whereas lower MPCC scores were associated with shorter visits, adjustment for visit length and standardized patient detection did not affect the relationship with expenditures. Total (testing, ambulatory and hospital care) expenditures were also greater for physicians who had lower MPCC scores, an effect primarily associated with the effect on testing expenditures. CONCLUSIONS: Patient-centered communication is associated with fewer diagnostic testing expenditures but also with increased visit length. Because costs and visit length may affect physicians' and health systems' willingness to endorse and practice a patient-centered approach, these results should be confirmed in future randomized trials.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 415-421 |
| Number of pages | 7 |
| Journal | Annals of Family Medicine |
| Volume | 3 |
| Issue number | 5 |
| DOIs | |
| State | Published - Sep 2005 |
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Keywords
- Communication
- Diagnostic tests, routine
- Evaluation studies
- Health care delivery
- Health care economics
- Health expenditures
- Physician-patient relations
- Standardized patients
ASJC Scopus subject areas
- Family Practice
Cite this
Patient-centered communication and diagnostic testing. / Epstein, Ronald M.; Franks, Peter; Shields, Cleveland G.; Meldrum, Sean C.; Miller, Katherine N.; Campbell, Thomas L.; Fiscella, Kevin.
In: Annals of Family Medicine, Vol. 3, No. 5, 09.2005, p. 415-421.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Patient-centered communication and diagnostic testing
AU - Epstein, Ronald M.
AU - Franks, Peter
AU - Shields, Cleveland G.
AU - Meldrum, Sean C.
AU - Miller, Katherine N.
AU - Campbell, Thomas L.
AU - Fiscella, Kevin
PY - 2005/9
Y1 - 2005/9
N2 - PURPOSE: Although patient-centered communication is associated with improved health and patient trust, information about the impact of patient-centered communication on health care costs is limited. We studied the relationship between patient-centered communication and diagnostic testing expenditures. METHODS: We undertook an observational cross-sectional study using covert standardized patient visits to study physician interaction style and its relationship to diagnostic testing costs. Participants were 100 primary care physicians in the Rochester, NY, area participating in a large managed care organization (MCO). Audio recordings of 2 standardized patient encounters for each physician were rated using the Measure of Patient-Centered Communication (MPCC). Standardized diagnostic testing and other expenditures, adjusted for patient demographics and case-mix, were derived from the MCO claims database. Analyses were adjusted for demographics and standardized patient detection. RESULTS: Compared with other physicians, those who had MPCC scores in the lowest tercile had greater standardized diagnostic testing expenditures (11.0% higher, 95% confidence interval [CI], 4.5%-17.8%) and greater total standardized expenditures (3.5% higher, 95% CI, 1.0%-6.1%). Whereas lower MPCC scores were associated with shorter visits, adjustment for visit length and standardized patient detection did not affect the relationship with expenditures. Total (testing, ambulatory and hospital care) expenditures were also greater for physicians who had lower MPCC scores, an effect primarily associated with the effect on testing expenditures. CONCLUSIONS: Patient-centered communication is associated with fewer diagnostic testing expenditures but also with increased visit length. Because costs and visit length may affect physicians' and health systems' willingness to endorse and practice a patient-centered approach, these results should be confirmed in future randomized trials.
AB - PURPOSE: Although patient-centered communication is associated with improved health and patient trust, information about the impact of patient-centered communication on health care costs is limited. We studied the relationship between patient-centered communication and diagnostic testing expenditures. METHODS: We undertook an observational cross-sectional study using covert standardized patient visits to study physician interaction style and its relationship to diagnostic testing costs. Participants were 100 primary care physicians in the Rochester, NY, area participating in a large managed care organization (MCO). Audio recordings of 2 standardized patient encounters for each physician were rated using the Measure of Patient-Centered Communication (MPCC). Standardized diagnostic testing and other expenditures, adjusted for patient demographics and case-mix, were derived from the MCO claims database. Analyses were adjusted for demographics and standardized patient detection. RESULTS: Compared with other physicians, those who had MPCC scores in the lowest tercile had greater standardized diagnostic testing expenditures (11.0% higher, 95% confidence interval [CI], 4.5%-17.8%) and greater total standardized expenditures (3.5% higher, 95% CI, 1.0%-6.1%). Whereas lower MPCC scores were associated with shorter visits, adjustment for visit length and standardized patient detection did not affect the relationship with expenditures. Total (testing, ambulatory and hospital care) expenditures were also greater for physicians who had lower MPCC scores, an effect primarily associated with the effect on testing expenditures. CONCLUSIONS: Patient-centered communication is associated with fewer diagnostic testing expenditures but also with increased visit length. Because costs and visit length may affect physicians' and health systems' willingness to endorse and practice a patient-centered approach, these results should be confirmed in future randomized trials.
KW - Communication
KW - Diagnostic tests, routine
KW - Evaluation studies
KW - Health care delivery
KW - Health care economics
KW - Health expenditures
KW - Physician-patient relations
KW - Standardized patients
UR - http://www.scopus.com/inward/record.url?scp=22244446235&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=22244446235&partnerID=8YFLogxK
U2 - 10.1370/afm.348
DO - 10.1370/afm.348
M3 - Article
C2 - 16189057
AN - SCOPUS:22244446235
VL - 3
SP - 415
EP - 421
JO - Annals of Family Medicine
JF - Annals of Family Medicine
SN - 1544-1709
IS - 5
ER -