Abstract
ABSTRACT Objective: To test the hypothesis that caregivers’ or adult participants’ low ratings of provider communication are associated with more hospital admissions among adults and children with sickle cell disease (SCD), respectively. Secondarily, we determined whether there was an association between the caregivers’ or participants’ health literacy and rating of providers’ communication. Methods: Primary data were collected from participants through surveys between 2014 and 2016, across six sickle cell centers throughout the U.S. In this cross-sectional cohort study, 211 adults with SCD and 331 caregivers of children with SCD completed surveys evaluating provider communication using the Consumer Assessment of Healthcare Providers and Systems (CAHPS), healthcare utilization, health literacy, and other sociodemographic and behavioral variables. Analyses included descriptive statistics, bivariate analyses, and logistic regression. Results: Participants with better ratings of provider communication were less likely to be hospitalized (odds ratio (OR) = 0.54, 95% confidence interval (CI) = [0.35, 0.83]). Positive ratings of provider communication were associated with fewer readmissions for children (OR = 0.23, 95% CI = [0.09, 0.57]). Participants with better ratings of provider communication were less likely to rate their health literacy as lower (regression coefficient (B) = −0.28, 95% CI = [−0.46, −0.10]). Conclusions: Low ratings of provider communication were associated with more hospitalizations and readmissions in SCD, suggesting the need for interventions targeted at improving patient-provider communication which could decrease hospitalizations for this population.
Highlights
Sickle cell disease (SCD) is a hereditary disorder of hemoglobin within the red blood cells, affecting over 100,000 Americans, many of whom face health disparities [1–4.] With improvements in care, SCD has become a chronic disease that affects both children and adults [5]
We used two psychometrically validated composites from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) to measure provider communication and shared decision-making[27–32.] We evaluated provider-patient communication within the framework of other contextual factors, such as social and behavioral determinants of health, given the high burden of social determinants of health in SCD and the influence of these factors on health utilization and outcomes[33, 34]
We reported descriptive statistics for the CAHPS items and conducted confirmatory factor analysis (CFA) to examine if the six items could be grouped into the two composites, provider communication and shared decision making, as hypothesized
Summary
Sickle cell disease (SCD) is a hereditary disorder of hemoglobin within the red blood cells, affecting over 100,000 Americans, many of whom face health disparities [1–4.] With improvements in care, SCD has become a chronic disease that affects both children and adults [5]. Despite improvements in SCD management, significant challenges persist, including a significant burden of hospitalizations [4, 6,7,8,9], costs over $900,000 by the age of 45 years [10], poor adherence to preventive care, including missing appointments [11,12,13,14,15,16,17], and lack of providers with knowledge and expertise in the disease [18–20.] A poor provider-patient relationship, an important indicator of patient experience and healthcare quality, can contribute to these challenges. Inadequate provider communication has been shown to lead to unfavorable outcomes in other diseases such as high blood pressure, anxiety, pain in postoperative situations, and problem and symptom resolution [21, 22]
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