Studying Physician Effects on Patient Outcomes : Physician Interactional Style and Performance on Quality of Care Indicators  

Oleh:

Franks, Peter ; Jerant, Anthony ; Fiscella, Kevin ; Shields, Cleveland G. ; Tancredi, Daniel J. ; Epstein, Ronald M.

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: Social Science & Medicine (www.elsevier.com/locate/sosscimed) vol. 62 no. 2 (Jan. 2006), page 422-432.
Topik: QUALITY OF CARE; USA; provider patient communication quality of care; multilevel analysis; adherence

Ketersediaan

Perpustakaan Pusat (Semanggi) Nomor Panggil: SS53.1 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Many prior studies which suggest a relationship between physician interactrional style and patient outcomes may have been confounded by relying likely on patient reports, examining very few patients per physician or not demonstrating evidence of a physician effects on the outcomes. We examined whether physician interactional style, measured both by patient report and objective encounter ratings, is related to performances on quality of care indicators. We also tested for the presence of physician effects on the performance indicators. Using data on 100 US primary care physician (PCP) claims data on 1,21,606 of their managed care patients, survey data on 4746 of their visiting patients, and audiotaped encounters of 2 standardized patients with each physicians, we examined the relationships between claims based quality of care indicators and both survey derived patient encoutners. Multi level models examined whether physician effects (variance components) on care indicators were mediated by patient perceptions or objective ratings of interactional style. We found significant physician effects associated with glycohemoglobin and cholesterol testing. There was also aclinically significant association between better patient perceptions of their physicians and more glycohemoglobin testing. Multilevel analyzed revealed, however that the physician effect on helycohemoglobin testing was not mediated by patient perveiced physician interaction style. In conclusion, similar to prior studies, we found evidence of an apparent relationship between patient perceptions of their physicians and patient care processes do not reflect physician style, but presumably reflect unmeasured patient coflunding. Multi level modeling may contribute to better inderstanding of the relationships between physician style and patient outcomes.

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