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The Influence of Patient-Centeredness on Asian Patients’ Satisfaction, Likelihood to Recommend, and Ratings of Quality. Stephen J. Aragon AMERICAN SOCIETY OF BUSINESS AND BEHAVIORAL SCIENCES 18 th ANNUAL MEETING, LAS VEGAS, NEVADA FE2BRUARY 24-27, 2011.

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The Influence of Patient-Centeredness on Asian Patients’ Satisfaction, Likelihood to Recommend, and Ratings of Quality

Stephen J. Aragon

AMERICAN SOCIETY OF BUSINESS AND BEHAVIORAL SCIENCES

18th ANNUAL MEETING, LAS VEGAS, NEVADA

FE2BRUARY 24-27, 2011

non conflict of interest certification
Non-Conflict of Interest Certification

The research upon which this presentation is based was sponsored by The National Institutes of Health National and Center on Minority Health and Health Disparities through The Provider Patient-Centeredness and Disparities Outcome Measurement Initiative (NIH/NCMHD-1P20MD002303-04).

I certify that neither I nor any member of my family has a material financial relationship, bias or ethical conflict, which will prevent me from making this presentation solely on the basis of its merits.

Stephen J. Aragon, PhD, MHA

Principal Investigator

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presentation
Presentation

The Grant

The Underlying Theory

Some empirical evidence supporting patient-centeredness’ influence on outcomes

Closing comments and answer questions

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The Provider Patient-Centeredness and Disparities Outcome Measurement Initiative (NIH/NCMHD-1P20MD002303-04)

the provider patient centeredness and disparities outcome measurement initiative
The Provider Patient-Centeredness and Disparities Outcome Measurement Initiative

5-year $700,000 grant funding empirical research, which will be translated into outcomes to help improve quality and reduce disparities for minority patients, women, and children

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specific aims
Specific Aims

Establish that patient-centeredness is an underlying ability of healthcare providers

Establish that the patient-centeredness of health providers affects the outcomes of minority patients, women, and children

Establish that the effect of provider patient-centeredness on outcomes is stable across patients, providers, and settings

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specific aims1
Specific Aims

Develop a patient-centeredness graduate course for medical, nursing, and allied health students

Develop a patient-centeredness certificate program for health providers

Develop an inventory for measuring the patient-centeredness of health providers

Increase the number of minority researchers involved in patient-centeredness research

Conduct annual patient-centeredness symposiums

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The Primary Provider TheoryAn evidence-based generalizable theory of how the patient-centeredness of health providers affects desired outcomes

the primary provider theory
The Primary Provider Theory

Developed from observations and interviews with patients in hospitals and medical practices

It is exclusively based on principles that favor patients in healthcare encounters

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theory principles
Theory Principles

Clinical competency is a necessary but insufficient condition of desired health outcomes.

Desired outcomes require more than clinical competency alone, because delivery of medical care requires interaction with patients.

The sourceof patient-centered care is patient-centered providers, not proclamations, policies, or procedures.

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theory principles1
Theory Principles

Patient-centeredness is the ability of health providers that affects the quality of their interaction with patients.

Providers are solely responsible for the quality of their interaction with their patients.

Patients and their families value both the patient-centeredness and clinical competency of providers.

Providers who are patient-centered and clinically competent are more likely to achieve desired outcomes.

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theory principles2
Theory Principles

Healthcare providers must, above all else, protect the best interests of their patients first.

The patient-centeredness of healthcare providers is more important than profit in any single health encounter.

Patients are the best judges of the patient-centeredness of their providers.

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patient centeredness iq
High

Empathetic, communicative, interested in patient’s feelings

Tactful, skilled in relationships with patients

Grasp patients’ needs, preferences, values, and concerns

Protect patient’s best interests above all else

Earn patients’ trust, satisfaction, confidence, high ratings, loyalty

Low

Aloof, uncommunicative, less interested in patient’s feelings

Less tactful and skilled in relationships with patients

Less concerned with patient’s needs, preferences, values, and concerns

Subordinate patient’s best interests to other interests

Tend not to earn patients’ trust, satisfaction, confidence, high ratings, loyalty

Patient-Centeredness IQ

*Note: High patient-centeredness ability reflects emotional stability, agreeableness, conscientiousness, ethical behavior, interpersonal sensitivity, while low ability reflects more dysfunctional dispositions or relationship derailers, e.g., moody, inconsistent, cynical, distrustful, indifferent, prejudices, critical of others, etc., and personality disorders.

the primary provider theory1
The Primary Provider Theory

Patient

Centerednessof Provider

Patient

Centerednessof Waiting

effect

effect

effect

Patient

Outcomes

Patient

Centerednessof Associates

effect

effect

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Empirical EvidenceSupporting the hypothesis that patient-centeredness is an ability of healthcare providers that affects the quality of their interaction with patients and related outcomes

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Does Pediatric Patient-Centeredness Affect Family Trust? Aragon, S. J., McGuinn, L., Bavin, S. A. and Gesell, S. B., Does Pediatric Patient-Centeredness Affect Family Trust? Journal for Healthcare Quality, 32: 23–31, May/June 2010. http://onlinelibrary.wiley.com/doi/10.1111/j.1945-1474.2010.00092.x/full

research questions
Research Questions

Does nursing patient-centeredness affect Medicaid patient satisfaction?

If yes, how much?

Is the influence of patient-centeredness stable across samples?

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measures
Measures

Nursing Patient-Centeredness

N1 Friendliness and courtesy

N5 Kept patient informed

N3 Attitude toward requests

N4 Amount of attention

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measures1
Measures

Medicaid Patient Satisfaction

03 Likelihood of recommending hospital

04 Overall rating of care

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samples
Samples

Random samples

Total N = 605

Group 1, N = 294

Group 2, N = 311

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results standardized
Results (standardized)

The model fit. Pediatric physician patient-centeredness significantly affected (.95) family trust.1, 2

It explained 89% of family trust.1

2 = 64.87, df = 69, p = .619; RMSEA = .000, p = 1.00; CFI = 1.00; R2 = .89

p < .001

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results standardized1
Results (standardized)

The effect was stable across both samples.3,4

The model held versus the competing model.4

Gender had no significant effect on family trust.5

p < .001

2 = 13.94, df = 17, p = .671

P > .62

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conclusion
Conclusion

The patient-centeredness of pediatricians significantly positively influenced their (1) care behaviors with patients and (2) increased family trust, confidence, and the likelihood to recommend the pediatrician to others by .946, .904, and .863 across both samples.

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closing
Closing
  • DHHS established the reality of wide-spread health disparities the first National Healthcare Disparities Report almost 40 years ago.
  • The most recent Report states "disparities related to race, ethnicity, and economic status still pervade the American health care system."
  • Somehow all the science and technology, splendid hospitals, prestigious medical schools and board certified physicians are not enough. Something clinical competency is needed.
closing1
Closing
  • Patient-Centeredness is the ability of healthcare providers that affects the quality of their interaction with patients and related outcomes.
  • Patient-Centeredness is a measurable, teachable, and can improve quality and outcomes.
    • The Primary Provider Theory is an evidence-based measurement model for designing patient-centeredness outcome studies.
closing2
Closing
  • The Theory’s robustness and stability established across:
    • Patients - African American and Black, American Indian and Alaskan Native, Asian, family practice, cardiology, dental, obstetrical, medical, surgical, emergency, across gender, time, age, and insurance type
    • Providers - physicians, nurses, mid-level practitioners, and dentists
    • Settings - hospitals, medical practices, clinics, and emergency departments
grant s significance
Grant’s Significance

Offers another path to help prevent and overcome disparities.

Provides empirical evidence that the patient-centeredness of providers affects desired outcomes for minority patients, women, and children.

Will establish the yard stick for measuring the patient-centeredness of providers for assessment, selection, and training to improve quality.

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significance
Significance

Will help increase the number of minority patient-centeredness researchers.

Can help increase the number of patient-centered providers over time.

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empirical investigations
Empirical Investigations

How the patient-centeredness of obstetrical nurses affects the satisfaction of Medicaid OB patients

How the patient-centeredness of physicians and nurses affects the satisfaction of Black and African American female medical, obstetrical, and surgical inpatients

How physician and nursing patient-centeredness affects male American Indian and Alaskan Native patient satisfaction, likelihood to recommend, and ratings of care

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empirical investigations1
Empirical Investigations

How nursing patient-centeredness affects the satisfaction of Black and African American female Medicare patients’ satisfaction

How the patient-centeredness of physicians affects Asian patient satisfaction, likelihood of recommending the hospital, and ratings of care

How the patient-centeredness of nurse practitioners affects patient trust, confidence and likelihood to recommend across national random samples of pediatric, internal medicine and family practice patients

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empirical investigations2
Empirical Investigations

How the patient-centeredness of cardiovascular physicians affects patient trust, confidence, and loyalty

How the patient-centeredness of nurse practitioners, waiting time, and nursing affects the likelihood to return of female family practice patients

How the patient-centeredness of pediatricians affects family trust, confidence, and likelihood to recommend the pediatrician

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