Date of Award

5-1-2014

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Field of Study

Health Management and Policy

Department

School of Public Health

First Advisor

Nuha Lackan

Second Advisor

Jose Pagán

Third Advisor

Kristine A. Lykens

Abstract

Shared decision-making (SDM) within the healthcare environment is grounded in open communication between patients and their care providers. In SDM, clinical and comparative effectiveness information are synthesized with patient values and treatment goals in order to arrive at treatment plans. Researchers and policymakers hope that SDM will facilitate enhanced treatment compliance and quality of care delivery, while simultaneously controlling unnecessary healthcare utilization and costs. The specific aims of this study sought to determine whether six individual SDM practices had an impact on healthcare utilization, healthcare expenditures, and patient reported satisfaction with care among patients with three preference-sensitive health conditions: angina, cancer, and osteoarthritis/joint pain. Data from the Medical Expenditure Panel Survey were used to determine if six individual SDM practices were significant predictors of healthcare utilization, healthcare expenditures, and patient satisfaction with care. Results indicate that patients reporting that providers explained information in a manner that was easy to understand and showed respect for what patients had to say experienced lower incidence rate ratios of outpatient care utilization (IRR=0.9270, 95% CI 0.8616-0.9975; IRR=0.8900, 95% CI 0.8295-0.9549). Those reporting their providers showed respect for what they had to say also experienced lower outpatient care expenditures on average than those whose providers did not show respect for what they had to say ($2,964.69 vs. $2,619.27, difference=-$345.42, p=0.0400). Patients who reported that providers explained all treatment options experienced $87.97 per year more in emergency department expenditures and $1,198.07 per year more in inpatient hospital expenditures than those who reported their providers did not explain all of the treatment options when a medical decision was to be made (p=0.0252; p=0.0036). All six SDM practices were significant predictors of patient satisfaction with care. Provider communication practices have a significant impact on aspects of care utilization and expenditures among patients with angina, cancer, and osteoarthritis/joint pain. Patient-perceived experiences of SDM practices are significant predictors of patient satisfaction with care among patients with these conditions. Effective communication is imperative during medical decisions in order to help ensure the value and quality of healthcare delivery to patients with angina, cancer, and osteoarthritis/joint pain.

Comments

Brown Philpot, Lindsey M. Impact of Shared Decision Making Practices on Healthcare Utilization, Healthcare Expenditures, and Satisfaction with Care among Patients with Angina, Cancer, and Osteoarthritis/Joint Pain, Medical Expenditure Panel Survey 2007-2010. Doctor of Philosophy (Health Services and Policy), May 2014, 134 pp. 16 tables, 1 illustration, bibliography, 95 titles.