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2006 National Healthcare Quality Report

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Chapter 5. Patient Centeredness

Patient centeredness is defined as: “[H]ealth care that establishes a partnership among practitioners, patients, and their families (when appropriate) to ensure that decisions respect patients' wants, needs, and preferences and that patients have the education and support they need to make decisions and participate in their own care.”1 An important dimension of quality, patient centeredness “encompasses qualities of compassion, empathy, and responsiveness to the needs, values, and expressed preferences of the individual patient.”2

Importance and Measures

Morbidity and Mortality

  • Patient centered approaches to care that rely on building a provider-patient relationship, improving communication techniques, fostering a positive atmosphere, and promoting patients to actively participate in patient-provider interactions have been shown to improve the health status of patients.3,4
  • A patient centered approach has been shown to lessen the symptom burden on patients.5
  • Patient centered care encourages patients to comply with and adhere to treatment regimens.6
  • Patient centered care can reduce the chance of misdiagnosis due to poor communication.7

Cost

  • Patient centeredness has been shown to reduce both underuse and overuse of medical services.8
  • Patient centeredness can reduce the strain on system resources or save money by reducing the number of diagnostic tests and referrals.5
  • Although some studies have shown that being patient centered reduces costs and use of health service resources, others have shown that patient centeredness increases costs to providers, especially in the short run.9

Measures

The NHQR tracks four measures of the patient experience of care. The core report measure is a composite of these measures which include patient assessments of how often their provider listened carefully to them, explained things clearly, respected what they had to say, and spent enough time with them. In addition, this year's NHQR reports on a supplemental measure that focuses on a composite measure of satisfaction with communication during the hospital stay.

Findings

Patient Experience of Care—Adults

Optimal health care requires good communication between patients and providers, yet barriers to patient-provider communication are common. To provide all patients with the best possible care, providers must be able to understand patients' diverse health care needs and preferences and communicate clearly with patients about their care.

Figure 5.1. Adults whose health providers sometimes or never listened carefully, explained things clearly, respected what they had to say, and spent enough time with them, by age group, 2000-2003

Figure 5.1. Adults whose health providers sometimes or never listened carefully, explained things clearly, respected what they had to say, and spent enough time with them, by age group, 2000-2003

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2000-2003.

Denominator: Civilian noninstitutionalized population age 18 and older who visited a doctor's office or clinic to get heath care in the past 12 months with valid answer to all four questions that comprise the composite measure.

  • In 2003, 9.8% of adults reported that their health providers sometimes or never listened carefully, explained things clearly, respected what they had to say, and spent enough time with them (Figure 5.1).
  • Between 2000 and 2003, the percentage decreased for the total population, indicating greater satisfaction. Most of this decrease occurred between 2002 and 2003.
  • Decreases were also seen from 2000 to 2003 for adults ages 45 to 64 and 65 and over. There was no significant change in the percentage for adults ages 18 to 44.
  • In all 4 data years, the proportion was lower among adults ages 45 to 64 and 65 and over compared with adults ages 18 to 44.

Figure 5.2. Adults age 18 and over whose health providers always listened carefully, explained things clearly, showed respect for what they had to say, and spent enough time with them, by State, 2004

Figure 5.2. Adults age 18 and over whose health providers always listened carefully, explained things clearly, showed respect for what they had to say, and spent enough time with them, by State, 2004

Source: Agency for Healthcare Research and Quality, Center for Quality Improvement and Patient Safety, National CAHPS® Benchmarking Database.

Key: Above average = rate is significantly above the all-States average in 2004. Below average = rate is significantly below the all-States average in 2004.

Denominator: Adults with Medicare fee-for-service benefits who visited a doctor's office or clinic in the past 12 months.

Note: “All-States average” is the average of all responding States (53 in this case, including the District of Columbia, Puerto Rico, and the U.S. Virgin Islands), which is a separate figure from the national average.

  • Individual State scores for this composite measurei of patient centeredness ranged from a low of 60.8% to a high of 73.1% (Figure 5.2).
  • In 2004, five Statesii were above the all-States average of 67.8% for this composite measure of patient centeredness.
  • Three Statesiii were below the all-States average for this measure in 2003.

i Note that respondents were asked to choose between “sometimes,” “never,” “usually,” or “always.” In contrast to Figure 5.1, the map shown in Figure 5.2 displays results for respondents answering “always.”
ii The States are Hawaii, Louisiana, Nebraska, New Hampshire, and Maine.
iii The States are Arizona, Nevada, and Florida.


Patient Experience of Care—Children

Communication in children's health care can pose a particular challenge as children are often less able to express their health care needs and preferences, and a third party (i.e., a parent or guardian) is involved in communication and decisionmaking. Optimal communication in children's health care can therefore have a significant impact on receipt of high quality care and subsequent health status.

Figure 5.3. Children whose parents or guardians report that their child's health providers sometimes or never listened carefully, explained things clearly, respected what they had to say, and spent enough time with them, 2001-2003

Figure 5.3. Children whose parents or guardians report that their child's health providers sometimes or never listened carefully, explained things clearly, respected what they had to say, and spent enough time with them, 2001-2003

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2001-2003.

Denominator: Civilian noninstitutionalized population less than 18 years old.

  • In 2003, 6.1% of parents and guardians reported that their child's health providers sometimes or never listened carefully, explained things clearly, respected what they had to say, and spent enough time with them. This rate is statistically unchanged from 2001. (Figure 5.3).

Focus on Patient Centeredness in Hospitals

When patients are admitted to a hospital, they often lose control of many aspects of their lives. However, the need for effective patient-provider communication is great in order to ensure that medical decisions are consistent with the patient's needs and preferences. In addition, patients can help providers avoid problems with medications and problems that may arise after they are discharged from the hospital.

To begin to capture information about patient perceptions of care when they are hospitalized, the Centers for Medicare & Medicaid Services and the Agency for Healthcare Research and Quality partnered to develop a standardized instrument, the CAHPS® Hospital Survey (H-CAHPS). In 2005, 254 U.S. hospitals volunteered to use this survey. In total, completed surveys were received from 84,779 respondents with an average response rate of 44%. Although it is not nationally representative, the sample of hospitals and respondents is comparable to the national distribution of hospitals registered with the American Hospital Association.10

The 2006 NHQR presents four composite measures from H-CAHPS in order to summarize the quality of communication that hospital patients experience during their stay. “Communication with doctors” summarizes responses to three questions, examining how often patients were treated with courtesy and respect by their doctors, how often doctors listened carefully, and how often doctors explained things in a way that patients were able to understand. “Communication with nurses” combines the same three questions in relation to nurses. “Communication about medications” combines responses from two questions, including how often hospital staff told patients the purpose of a new medicine and how often hospital staff described possible side effects in a way that patients could understand. “Discharge information” combines responses from two questions, including whether or not hospital staff spoke with patients about whether they would have the help they needed after leaving the hospital and whether or not patients reported receiving written information on symptoms or health problems of which they should be aware after discharge.

Figure 5.4. Hospital patients who reported sometimes or never having good communication with doctors, good communication with nurses, communication about new medications, and discharge information, 2005

Figure 5.4. Hospital patients who reported sometimes or never having good communication with doctors, good communication with nurses, communication about new medications, and discharge information, 2005

Source: Agency for Healthcare Research and Quality, Consumer Assessment of Health Plans Survey, 2005.

Denominator: Hospital patients.

  • In 2005, 6% of hospital patients reported sometimes or never having had good communication with their doctors during their stay (Figure 5.4).
  • In 2005, 7% of hospital patients reported sometimes or never having had good communication with their nurses during their stay.
  • In 2005, 26% of hospital patients reported sometimes or never having had good communication about new medications during their stay.
  • In 2005, 21% of hospital patients reported not receiving good discharge information.

References

1. Institute of Medicine. Envisioning the national health care quality report. Washington, DC: National Academies Press; 2001.

2. Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academies Press; 2001.

3. Stewart M, Brown JB, Donner A, et al. The impact of patient-centered care on outcomes. J Fam Pract 2000 Sep;49(9):796-804.

4. Anderson EB. Patient-centeredness: a new approach. Nephrol News Issues 2002 Nov; 16(12):80-2.

5. Little P, Everitt H, Williamson I, et al. Observational study of effect of patient centredness and positive approach on outcomes of general practice consultations. BMJ 2001 Oct 20;323(7318):908-11.

6. Beck R, Daughtridge R, Sloane PD. Physician-patient communication in the primary care office: a systematic review. J Am Board Fam Pract 2002 Jan-Feb; 15(1):25-38.

7. DiMatteo M. The role of the physician in the emerging health care environment. West J Med 1998 May; 168(5):328-33.

8. Berry L, Seiders K, Wilder SS. Innovations in access to care: a patient-centered approach. Ann Intern Med 2003 Oct 7; 139(7):568-74.

9. Bechel D, Myers WA, Smith DG. Does patient-centered care pay off? Jt Comm J Qual Improv 2000;26(7):400-9.

10. Agency for Healthcare Research and Quality. CAHPS® hospital survey chartbook: what patients say about their experiences with hospital care. Report of summary data from hospital test sites. Prepublication copy; March 2006. Available at: https://www.cahps.ahrq.gov/content/NCBD/PDF/HCAHPS_Chartbook_2006.pdf [PDF Help].

 

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