E. J. Cerier1, Q. Chen1, E. Beal1, A. Paredes1, S. Sun1, G. Olsen1, J. Cloyd1, M. Dillhoff1, C. Schmidt1, T. Pawlik1 1Ohio State University,Department Of Surgery,Columbus, OH, USA
Introduction: An optimal patient-provider relationship (PPR) may improve medication / appointment adherence, healthcare resource utilization, as well as reduce healthcare costs. The objective of the current study was to define the impact of PPR on healthcare outcomes among a cohort of patients with hepato-pancreato-biliary (HPB) diseases.
Methods: Utilizing the Medical Expenditure Panel Survey Database from 2008-2014, patients with an HPB disease diagnosis were identified. PPR was determined using a weighted score based on survey items from the Consumer Assessment of Healthcare Providers and Systems (CAHPS). Specifically, patient responses to questions concerning access to healthcare providers, responsiveness of healthcare providers, patient-provider communication, and shared decision-making were obtained. Patient provider communication was stratified into three categories using a composite score that ranged from 4 to 12 (score 4-7: "poor," 8-11: "average," and 12 "optimal"). The relationship between PPR and health care outcomes was analyzed using regression analyses and generalized linear modeling.
Results: Among 594 adult-patients, representing 6 million HPB patients, reported PPR was "optimal" (n=210, 35.4%), "average" (n=270, 45.5%), and "poor" (n=114, 19.2%). Uninsured (uninsured: 36.3% vs. Medicaid: 28.8% vs. Medicare: 15.4% vs. Private: 14.0%; p=0.03) and poor-income (high: 14.0% vs. middle: 12.8% vs. low: 21.5% vs. poor: 24.3%; p=0.03) patients were more likely to report "poor" PPR. In contrast, other factors such as race, sex, education, and age were not associated with PPR. In addition, there was no association between PPR and overall annual healthcare expenditures ("poor" PPR: $19,405, CI $15,207-23,602 vs. "average" PPR: $20,148, CI $15,538-24,714 vs. "optimal" PPR: $19,064, CI $15,344-22,784; p=0.89) or out-of-pocket expenditures ("poor" PPR: $1,341, CI $618-2,065 vs. "average" PPR: $1,374, CI $1,079-1,668 vs. "optimal" PPR: $1,475, CI $1,150-1,800; p=0.77). Patients who reported "poor" PPR were also more likely to self-report poor mental health scores (OR 5.0, CI 1.3-16.7), as well as have high emergency room utilization (≥ 2 visits: OR 2.4, CI 1.2-5.0)(both p<0.05). Patients with reported "poor" PPR did not, however, have worse physical health scores or more previous inpatient hospital stays (both p>0.05)(Figure).
Conclusion: Patient self-reported PPR was associated with insurance and socioeconomic status. In addition, patients with perceived "poor" PPR were more likely to have poor mental health and be high utilizers of the emergency room. Efforts to improve PPR should focus on these high-risk populations.
