1. A RADICAL RECONSTRUCTION OF PATIENT CENTEREDNESS
JE ROHRER, S MERRY, SA ADAMSON
October 2006

2. DEFINITION OF QUALITY VARIES BY LEVELDONABEDIAN

3. MOVING BEYOND PATIENT CENTERED COMMUNICATION TO PATIENT CENTERED CARE
MD does what he thinks is best for the pt taking into account pt concerns (clinical outcome measures)
MD adopts the pts goals (self-rated health, patient satisfaction, self-efficacy)
Team adopts the pt’s goals
Care system addresses pts in groups outside of the clinic, pursuing the goals of the typical person

4. Objectives
Patient centered communication (PCC) is often employed as a strategy for empowering patients. Is it the best approach?
The purpose of this study was to investigate the relationship between a direct measure of patient empowerment, feeling that one is in control of one’s own health (health confidence), and PCC.

5. Previous Research
Medical skepticism vs self-efficacy vs health confidence
Not previously used as a measure of empowerment
Validity of single question to measure health status is amply supported by prospective studies

6. Methods
A cross-sectional phone survey of family medicine patients treated in Mayo Clinic in Rochester, Minnesota (N=800)
Convenience sample, <40% response
Tested the theory that health confidence is related to satisfaction with several aspects of communication after adjusting for health status, age, and gender.

7. Specific Questions Asked
SRH--In general, how would you rate your overall health?
Confidence--In general, how would you rate your ability to take care of your own health without the help of a medical professional?

8. Descriptive Statistics (21% had high health confidence, N=800)
Variable % % with High p-value Confidence
Good SRH
Female
Age category
75 and over

9. Results
Being highly satisfied with overall communication, explanations, listening, use of understandable words, and involvement in decisions were positively associated with health confidence.
Self-rated health was more strongly related to health confidence than satisfaction with communication in every model tested (AORs ranged from ).

10. Six Multiple Logistic Regression Models of High Health Confidence
Ratings % in % High p Odds Ratio*
Of care as sample Confidence (Conf Int)
“excellent”
Overall quality ( )
Communication ( )
Explanations ( )
Listening ( )
Words ( )
Decisions ( )
*adjusted for age category, gender, and self-rated health

11. Conclusion
Reliance solely on patient centered communication to promote empowerment may be insufficient.
Also need to promote better self-rated health (health promotion)

12. Practice Implications
Suggested empowerment strategies:
promotion of PCC behaviors (specifically explanations, listening, using understandable language and involving patients in decision-making)
health promotion programs delivered to patient groups, sometimes by non-MDs