Patient-centered communication and diagnostic testing

Ronald M. Epstein, Peter Franks, Cleveland G. Shields, Sean C. Meldrum, Katherine N. Miller, Thomas L. Campbell, Kevin Fiscella

Research output: Contribution to journalArticle

196 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)415-421
Number of pages7
JournalAnnals of Family Medicine
Volume3
Issue number5
DOIs
StatePublished - Sep 2005

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Communication
Health Expenditures
Physicians
Managed Care Programs
Demography
Organizations
Confidence Intervals
Costs and Cost Analysis
Diagnosis-Related Groups
Health
Primary Care Physicians
Ambulatory Care
Health Care Costs
Cross-Sectional Studies
Databases

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

Epstein, R. M., Franks, P., Shields, C. G., Meldrum, S. C., Miller, K. N., Campbell, T. L., & Fiscella, K. (2005). Patient-centered communication and diagnostic testing. Annals of Family Medicine, 3(5), 415-421. https://doi.org/10.1370/afm.348

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 journalArticle

Epstein, RM, Franks, P, Shields, CG, Meldrum, SC, Miller, KN, Campbell, TL & Fiscella, K 2005, 'Patient-centered communication and diagnostic testing', Annals of Family Medicine, vol. 3, no. 5, pp. 415-421. https://doi.org/10.1370/afm.348
Epstein RM, Franks P, Shields CG, Meldrum SC, Miller KN, Campbell TL et al. Patient-centered communication and diagnostic testing. Annals of Family Medicine. 2005 Sep;3(5):415-421. https://doi.org/10.1370/afm.348
Epstein, Ronald M. ; Franks, Peter ; Shields, Cleveland G. ; Meldrum, Sean C. ; Miller, Katherine N. ; Campbell, Thomas L. ; Fiscella, Kevin. / Patient-centered communication and diagnostic testing. In: Annals of Family Medicine. 2005 ; Vol. 3, No. 5. pp. 415-421.
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