Measures Of Patient-centered Care Research Articles

Patient-centered care measures through the eyes of South African Radiographers and patients: A survey approach

BackgroundWorldwide there has been a shift in the ideology within healthcare systems that focuses on ‘people’ rather than the ‘patients’. A patient should not only be perceived by their condition but rather viewed holistically as a person. Within a South African (SA) context, the constitution has been amended to state that all South African citizens have the right to healthcare that is caring, free from harm, and effective. Hence, it can be rationalized that patient-centered care (PCC) is a necessary and vital approach in South African healthcare as well. A study conducted by Hyde and Hardy in the United Kingdom (UK) explored measures of PCC from radiography patients, radiographers, radiography managers, radiography educators, and radiography students' perspectives. This study was duplicated to define informed measures of PCC from a South African perspective. Therefore, this study aimed to gain perspectives on PCC measures in diagnostic radiography within a sample of the South African community. This paper focuses on the perspectives of the clinical radiographer and patient respondents. MethodThis study was conducted using a quantitative approach with the use of an online survey. The Qualtrics software was utilized to design the survey. The survey consisted of three PCC themes; use of technology, comfort and emotional support, and control over the environment. Recruitment of the subgroups was via advertisement in social media, email networks, and word of mouth. ResultsThere were 28 radiographer responses and 14 patient responses. The data were analyzed using SPSS software version 28. Patient care while explaining the use of technology in radiography, received positive responses from both respondent groups. Patient care measures that explored comfort and emotional support received varied responses from patients and radiographers. Important PCC concepts, such as asking the patient about their care needs and health problems, were lacking. Patients indicated that radiographers do not include their family members in the discussion of the care needs even though family involvement is a PCC element. ConclusionThe perceptions of PCC measures differed between the two groups which indicated that there are still some gaps in clinical practice. Patient involvement in their care and individualized care should be prioritized. There is a need for family involvement during radiography procedures to be better highlighted within clinical practice. It is also recommended that more importance be placed on PCC during undergraduate training. While service delivery is important, radiographers must not disregard their PCC responsibilities towards the patient.

Patient-centered inpatient psychiatry is associated with outcomes, ownership, and national quality measures.

Following discharge from inpatient psychiatry, patients experience elevated suicide risk, unplanned readmission, and lack of outpatient follow-up visits. These negative outcomes might relate to patient-centered care (PCC) experiences while hospitalized. We surveyed 739 former patients of inpatient psychiatric settings to understand the relationship between PCC and changes in patients' trust, willingness to engage in care, and self-reported 30-day follow-up visits. We also linked PCC measures to facility-level quality measures in the Inpatient Psychiatric Facility Quality Reporting program. Relative to patients discharged from facilities in the top quartile of PCC, those discharged from facilities in the bottom quartile were more likely to experience reduced trust (predicted probability [PP] = 0.77 vs 0.46; P < .001), reduced willingness to go to the hospital voluntarily (PP = 0.99 vs 0.01; P < .001), and a lower likelihood of a 30-day follow-up (PP = 0.71 vs 0.92; P < .001). PCC was lower among patients discharged from for-profits, was positively associated with facility-level quality measures of 7- and 30-day follow-up and medication continuation, and was inversely associated with restraint use. Findings underscore the need to introduce systematic measurement and improvement of PCC in this setting.

Mobile health platform for self-management of pediatric cystic fibrosis: Impact on patient-centered care outcomes

Previously, we adapted a mobile health platform (Genia) to the needs of patients and families in a pediatric CF center in the United States. In this feasibility study, we tested the impact of Genia on measures of patient-centered care. In a one-group pre-post study with adolescents with CF and caregivers of children with CF, we tested Genia's effect over 6 months on patient satisfaction with chronic illness care (PACIC) and shared decision-making (CollaboRate). Feasibility and acceptability were assessed with exit interviews and app analytics. The intervention included 40 participants: 30 caregivers of children with CF age ≤14 years and 10 patients with CF age ≥15 years. The use of Genia was associated with increased satisfaction with care (p=0.024), including delivery system and decision support (p=0.017), goal setting (p=0.006), and shared decision-making (p<0.001). The use of Genia was associated with nominal improvements in all QOL domains and symptom scales. The platform was feasible, with participants recording more than 4,400 observations (mean 84.2) and submitting 496 weekly reports (mean 13.8) and 70 quarterly reports (mean 1.8), and acceptable (95% retention rate). For participants, the most useful app feature was pre-visit reports (66.7%), and the top symptom trackers were those for cough (23.7%), appetite (21.1%), energy (18.4%), and medicines (18.4%). The use of Genia over 6 months was feasible, acceptable, and associated with improved measures of patient-centered care. Study results support wider use of Genia in clinical settings. Efficacy for clinical outcomes should be assessed in a randomized clinical trial.

On the relation between decision quality and autonomy in times of patient-centered care: a case study.

It is commonplace that care should be patient-centered. Nevertheless, no universally agreed-upon definition of patient-centered care exists. By consequence, the relation between patient-centered care as such and ethical principles cannot be investigated. However, some research has been performed on the relation between specific models of patient-centered care and ethical principles such as respect for autonomy and beneficence. In this article, I offer a detailed case study on the relationship between specific measures of patient-centered care and the ethical principle of respect for autonomy. Decision Quality Instruments (DQIs) are patient-centered care measures that were developed by Karen Sepucha and colleagues. The model of patient-centered care that guided the development of these DQIs pays special attention to the ethical principle of respect for autonomy. Using Jonathan Pugh's theory of rational autonomy, I will investigate how the DQIs relate to patient autonomy. After outlining Pugh's theory of rational autonomy and framing the DQIs accordingly (Part I), I will investigate whether the methodological choices made while developing these DQIs align with respect for autonomy (Part II). My analysis will indicate several tensions between DQIs and patient autonomy that could result in what I call "structural paternalism." These tensions offer us sufficient reasons, especially given the importance of the ethical principle of respect for autonomy, to initiate a more encompassing debate on the normative validity of Decision Quality Instruments. The aim of the present paper is to highlight the need for, and to offer a roadmap to, this debate.

Patient-centered primary care and receipt of evidence-based alcohol-related care in the national Veterans Health Administration

BackgroundHealth care systems are increasingly integrating screening and care for unhealthy alcohol use into primary care settings. However, gaps remain in receipt of evidence-based care after the detection of unhealthy alcohol use. Patient-centered primary care may be an important determinant of alcohol-related care receipt, but its role is underexamined. MethodsWe examined associations between previously developed, clinic-level measures of patient-centered care (indicative of medical home model implementation) and receipt of alcohol-related care in a national cohort of VA patients who screened positive for unhealthy alcohol use (defined by AUDIT-C alcohol screen of ≥5; n = 568,909) for whom brief intervention is recommended. We also assessed alcohol-related care in a subsample of these patients with a past-year alcohol use disorder (AUD) diagnosis (n = 144,511) for whom specialty addictions care and medications are recommended. The study used modified Poisson models to assess associations between measures of patient-centered care and individual-level receipt of recommended alcohol-related care. We presented prevalence ratios (PR) and marginal probabilities to illustrate relative and absolute differences, respectively, in outcomes associated with clinic-level measures. ResultsCompared to patients in the lowest-ranked clinics, patients were more likely to receive brief intervention in clinics with the highest rankings of self-management support (PR: 1.06; 95% CI: 1.10, 1.11), communication (PR: 1.08; 95% CI: 1.04, 1.12), access (PR: 1.11; 95% CI: 1.06, 1.17), and care coordination (PR: 1.09; 95% CI: 1.03, 1.15). The study also observed a greater likelihood of receiving AUD medications among those receiving care at clinics with higher ratings of comprehensiveness (PR: 1.35; 95% CI: 1.10, 1.66) and shared decision-making (PR: 1.35; 95% CI: 1.12, 1.61); higher clinic-level access ratings were associated with specialty addictions care (PR: 1.15; 95% CI: 1.00, 1.32). Patients in the clinics with the highest summary patient-centered care ratings, compared to the lowest, had higher likelihoods of receiving brief intervention (PR: 1.07; 95% CI: 1.03, 1.12) and medications (PR: 1.16; 95% CI: 1.00, 1.35). The study did not identify any other statistically significant findings. ConclusionsThis observational study found that dimensions of patient-centered care were associated with increased receipt of recommended alcohol-related care. Future studies should investigate strategies to improve patients' experience of alcohol-related care.

Patients’ experiences and satisfaction with health care in the Salah Azaiez Institute of Cancer in Tunisia in 2020

Measurement of patient-centered care is a key step to ensure quality of care improvement. The aims of this study were to evaluate the experience of hospitalized patients of Salah Azaiez Institute (SAI) of Cancer of Tunisia in 2020 and to analyze factors associated to the global satisfaction. It was a cross-sectional study. The used questionnaire was derived from the Picker patient questionnaire. Factors associated to the global satisfaction were assessed using Chi-squared and Fisher’s exact tests. The present study concerned 200 inpatients of the SAI. The Cronbach’s α of the patient experience test (PPE-15) was of 0.82 indicating a good internal consistency. According to results of this study, only 38.5% of the patients were satisfied with their hospitalization. Perception of the quality of the received treatment was good to excellent for 57.0%. Regarding the global organization, 56.5% of the patients found it intermediate and 21.5% perceived it as bad. The highest scores among patient experience dimensions concerned the coordination of healthcare, the respect for patient preference and the physical comfort. However, lowest scores were attributed to the involvement of family and friends, the information and patient education and the emotional support. Unlike socio-demographic factors, patient experience and its dimensions was strongly associated to the global satisfaction. Further studies are recommended to explore patient experience dimensions and other determinants of patient satisfaction in Tunisia.

Impacts of Patient‐Centered Inpatient Psychiatric Care on Trust and Post‐Discharge Engagement with Care

Research ObjectiveInpatient psychiatry lacks empirical evidence for its benefits, with some evidence of iatrogenic harm. Research suggests that safety events, including restraint and seclusion, are not uncommon. Within 30‐days of discharge, the risk for suicide is 180 times the rate in the general population, about a third of patients have an unplanned readmission, and only about 50% have a follow‐up appointment. These increased risks for negative outcomes and disengagement with care might relate to the quality of inpatient care experiences, yet research investigating these associations is sparse.The current study aimed to understand the relationship between patients' reports of patient‐centered care (PCC) in inpatient psychiatry and proximal outcomes of trust and post‐discharge engagement with care. This is the first known study to examine these relationships.Study DesignWe used a retrospective cohort design. Participants were recruited online in 2021 and administered a survey. PCC was measured using a valid and reliable instrument, the Combined Assessment of Psychiatric Environments. Participants were asked to report the degree of trust they had in the hospital at time of admission, the extent to which their trust in mental health providers decreased or increased due to their hospitalization, the extent to which their willingness to disclose distressing thoughts to outpatient providers decreased or increased due to their hospitalization, and the extent to which their willingness to go to the hospital voluntarily decreased or increased due to their hospitalization. Participants also reported global impacts of the hospitalization on wellbeing (positive, negative, mixed, neutral), whether they received follow‐up care within 30‐days of discharge, clinical characteristics, and demographic characteristics.Logistic regression models were fit for each outcome, with PCC serving as the primary predictor. Models controlled for baseline trust/expectations in the quality of hospital care at time of admission, voluntary status, suicidality, prior admissions, demographic characteristics, and year.Population StudiedThe population included adults (18+) who were hospitalized for psychiatric treatment in the United States within the past five years.Principal FindingsA total of 733 participants completed the survey. Relative to those in the top quartile of PCC, those in the bottom quartile were more likely to have their trust reduced (predicted probability [PP] = 0.75 versus 0.40, p &lt; 0.001), willingness to disclose distressing thoughts reduced (PP = 0.63 versus 0.18, p &lt; 0.001), willingness to go to the hospital voluntarily reduced (PP = 0.86 versus 0.08, p &lt; 0.001), were more likely to report that the hospitalization had only a negative impact (PP = 0.53 versus 0.02, p &lt; 0.001), and were less likely to have a 30‐day follow‐up (PP = 0.68 versus 0.88, p &lt; 0.001).These patterns persisted when examining positive outcomes of increased trust and engagement, and were robust even when restricted to those hospitalized on an involuntary basis.ConclusionsLow ratings of PCC were associated with reported reductions in trust and decreased engagement, whereas high PCC was associated with increased trust and increased engagement.Implications for Policy or PracticeThese findings demonstrate the importance of PCC on outcomes. Payers and policy makers should expand patient experience measurement to inpatient psychiatry (e.g., HCAHPS). Systematic measurement of PCC could be used within feedback and incentive designs.Primary Funding SourceNational Institutes of Health.

Using Patient-Reported Outcomes toAssess Healthcare Quality: Toward Better Measurement of Patient-Centered Care in Cardiovascular Disease.

Patient-reported outcomes (PROs) are elicited directly from patients so they can describe their overall health status, including their symptoms, function, and quality of life. While commonly used as end points in clinical trials, PROs can play an important role in routine clinical care, population health management, and as a means for quantifying the quality of patient care. In this review, we propose that PROs be used to improve patient-centered care in the treatment of cardiovascular diseases given their importance to patients and society and their ability to improve doctor- provider communication. Furthermore, given the current variability in patients' health status across different clinics and the fact that PROs can be improved by titrating therapy, we contend that PROs have a key opportunity to serve as measures of healthcare quality.

Evaluating Patient-Centered Mobile Health Technologies: Definitions, Methodologies, and Outcomes.

Several recently published studies and consensus statements have demonstrated that there is only modest (and in many cases, low-quality) evidence that mobile health (mHealth) can improve patient clinical outcomes such as the length of stay or reduction of readmissions. There is also uncertainty as to whether mHealth can improve patient-centered outcomes such as patient engagement or patient satisfaction. One principal challenge behind the “effectiveness” research in this field is a lack of common understanding about what it means to be effective in the digital space (ie, what should constitute a relevant outcome and how best to measure it). In this viewpoint, we call for interdisciplinary, conceptual clarity on the definitions, methodologies, and patient-centered outcomes frequently used in mHealth research. To formulate our recommendations, we used a snowballing approach to identify relevant definitions, outcomes, and methodologies related to mHealth. To begin, we drew heavily upon previously published detailed frameworks that enumerate definitions and measurements of engagement. We built upon these frameworks by extracting other relevant measures of patient-centered care, such as patient satisfaction, patient experience, and patient activation. We describe several definitional inconsistencies for key constructs in the mHealth literature. In an effort to achieve clarity, we tease apart several patient-centered care outcomes, and outline methodologies appropriate to measure each of these patient-care outcomes. By creating a common pathway linking definitions with outcomes and methodologies, we provide a possible interdisciplinary approach to evaluating mHealth technologies. With the broader goal of creating an interdisciplinary approach, we also provide several recommendations that we believe can advance mHealth research and implementation.

Measuring patient-centered care for specific populations: A necessity for improvement

The measurement of patient-centered care (PCC) is a fundamental component of assessing and improving health care quality. There are a variety of PCC measures available which have been tailored to different health care conditions and settings. These distinct measures are valuable given the diversity of health conditions and contexts encountered in the health care system. However, the type of patient has received significantly less attention when measuring PCC despite the multitude of unique patient populations that exist. Specific patient populations raise several core challenges for PCC measurement to which researchers and practitioners need to attend: identifying what principles to measure, who is the most appropriate assessor, and how best to measure PCC. Examples of specific patient populations include geriatric patients, refugees, migrants and dyadic patients. Dyadic patients, such as the mother-infant dyad, are two individual, independent, yet inextricably linked patients who require simultaneous care. In this commentary, we use the mother-infant dyad as one example of a specific population to illustrate the challenges and argument for why additional specific patient populations warrant dedicated measures of PCC.

Improving Patient-Centered Care for Young People in General Practice With a Codesigned Screening App: Mixed Methods Study.

BackgroundDespite experiencing a high prevalence and co-occurrence of mental health disorders and health-compromising behaviors, young people tend not to seek professional help for these concerns. However, they do regularly attend primary care, making primary care providers ideally situated to identify and discuss mental health and lifestyle issues as part of young people’s routine health care.ObjectiveThe aim was to investigate whether using a codesigned health and lifestyle-screening app, Check Up GP, in general practice influenced young people’s assessment of the quality of their care (measures of patient-centered care and youth friendliness), and their disclosure of sensitive issues. In addition, this study aimed to explore young people’s acceptance and experience of using a screening app during regular health care.MethodsThis was a mixed methods implementation study of Check Up GP with young people aged 14 to 25 years attending a general practice clinic in urban Melbourne, Australia. A 1-month treatment-as-usual group was compared to a 2-month intervention group in which young people and their general practitioners (GPs) used Check Up GP. Young people in both groups completed an exit survey immediately after their consultation about disclosure, patient-centered and youth-friendly care, and judgment. In addition, participants in the intervention group were surveyed about app acceptability and usability and their willingness to use it again. Semistructured interviews with participants in the intervention group expanded on themes covered in the survey.ResultsThe exit survey was completed by 30 young people in the treatment-as-usual group and 85 young people in the intervention group. Young people using Check Up GP reported greater disclosure of health issues (P<.001), and rated their GP higher in patient-centered care: communication and partnership (P=.01), personal relationship (P=.01), health promotion (P=.03), and interest in effect on life (P<.001). No differences were found on core indicators of youth-friendly care: trust, level of comfort, expectations met, and time to ask questions. In all, 86% (73/85) of young people felt the app was a “good idea” and only 1% (1/85) thought it a “bad idea.” Thematic analysis of qualitative interviews with 14 participants found that Check Up GP created scope to address unmet health needs and increased sense of preparedness, with use moderated by honesty, motivation, app content and functionality, and app administration.ConclusionsIntegrating a health and lifestyle-screening app into face-to-face care can enrich young people’s experience of seeing their GP, create scope to identify and address unmet health needs, and increase patient-centered care. Further research is needed to investigate the effect of using a health and lifestyle-screening app in a diverse range of clinic types and settings, and with a diverse range of GPs and youth.

Assessing the Associations of Patient-Reported Perceptions of Patient-Centered Care as Supplemental Measures of Health Care Quality in VA.

Patient-reported experience measures (PREMs) are useful for assessing health care quality and safety and patients' perceptions of health care. We aimed to assess the relationship between PREMS [e.g., measures of patient-centered care (PCC)] and health care quality metrics. We conducted a national survey via mail. Survey data were supplemented with US Department of Veteran Affairs (VA) administrative data. Veteran (n = 5512) VA health care users participated in the study. PCC measures included: patient activation; shared decision-making(SDM); empathy and holistic care; chronic illness care; perceptions of participation, respect for choices, and support; and overall health care experience. Health care quality measures included: preventive care screening receipt; chronic condition management (diabetes, hypertension); and health care utilization (hospitalizations, emergency room (ER) visits). Analyses included: bivariate comparisons of PCC measures by health care quality measures; and multivariate linear regression to identify variables associated with attaining multiple positive health care quality indicators (when controlling for potential confounders). PREMs assessing factors relating to patient-provider communication (e.g., empathic provider care, shared decision-making) are mainly related to clinical indicators representing good chronic condition management, while those relating more broadly to health care in general (e.g., patient activation, chronic illness care) are mainly related to measures of appropriate health care use (e.g., preventive care screening receipt; potentially avoidable hospitalizations; unscheduled care, such as ER visits). When controlling for potential confounders, higher perceptions of the decision-making effectiveness component of SDM (β = 0.004, p = 0.03) and empathy and holistic care (β = 0.01, p = 0.02) showed a weak but positive relationship with attaining a greater number of positive health care quality indicators, while a weak but negative relationship emerged for perceptions of participation, respect for choices, and support (β = -0.003, p = 0.03) and overall VA experiences (β = -0.10, p = 0.04). PREMs that measure PCC offer rich data about health care quality while engaging patients, and considering patient experiences and preferences, in performance assessment. PREMs may be used to supplement existing performance metrics.

Measuring the quality of patient-centered care: why patient-reported measures are critical to reliable assessment.

PurposeThe Institute of Medicine (IOM) identified patient-centeredness as crucial to quality health care. The IOM endorsed six patient-centeredness dimensions that stipulated that care must be: respectful to patients’ values, preferences, and expressed needs; coordinated and integrated; provide information, communication, and education; ensure physical comfort; provide emotional support; and involve family and friends. Patient-reported measures examine the patient’s perspective and are essential to the accurate assessment of patient-centered care. This article’s objectives are to: 1) use the six IOM-endorsed patient-centeredness dimensions as a framework to outline why patient-reported measures are crucial to the reliable measurement of patient-centered care; and 2) to identify existing patient-reported measures that assess each patient-centered care dimension.MethodsFor each IOM-endorsed patient-centeredness dimension, the published literature was searched to highlight the essential role of patients in assessing patient-centered care and informing quality improvement efforts. Existing literature was also searched to identify examples of patient-reported measures that assess each patient-centeredness dimension.ConclusionPatient-reported measures are arguably the best way to measure patient-centeredness. For instance, patients are best positioned to determine whether care aligns with patient values, preferences, and needs and the Measure of Patient Preferences is an example of a patient-reported measure that does so. Furthermore, only the patient knows whether they received the level of information desired, and if information was understood and can be recalled. Patient-reported measures that examine information provision include the Lung Information Needs Questionnaire and the EORTC QLQ-INFO25. In relation to physical comfort, only patients can report the severity of physical symptoms and whether medications provide adequate relief. Patient-reported measures that investigate physical comfort include the Pain Care Quality Survey and the Brief Pain Inventory. Using patient-reported measures to regularly measure patient-centered care is critical to identifying areas of health care where improvements are needed.

Factors in patients’ experience of hospital care: Evidence from California, 2009–2011

The use of measures of patient-centered care to evaluate hospital care is mandated by The Patient Protection and Affordable Care Act of 2010. Using three years of data from 315 California acute-care hospitals and data collected from patients via the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, we seek to evaluate patients’ hospital-care experience by (1) analyzing patients’ experience-of-care scores in light of these hospitals’ patient profiles, structural characteristics, and outcomes in 2011, and (2) determining and analyzing the extent of changes in patients’ experience of care over the three-year period 2009–2011. For 2011, we find significant variation in patients’ experience-of-care scores associated with hospitals’ different patient profiles and structural characteristics. In spite of these single-year differences, virtually all aspects of patients’ experience of care showed improvement over the 2009-2011 period.

Measuring Primary Care Organizational Capacity for Diabetes Care Coordination: The Diabetes Care Coordination Readiness Assessment

Not all primary care clinics are prepared to implement care coordination services for chronic conditions, such as diabetes. Understanding true capacity to coordinate care is an important first-step toward establishing effective and efficient care coordination. Yet, we could identify no diabetes-specific instruments to systematically assess readiness and/or status of primary care clinics to engage in diabetes care coordination. This report describes the development and initial validation of the Diabetes Care Coordination Readiness Assessment (DCCRA), which is intended to measure primary care clinic readiness to coordinate care for adult patients with diabetes. The instrument was developed through iterative item generation within a framework of five domains of care coordination: Organizational Capacity, Care Coordination, Clinical Management, Quality Improvement, and Technical Infrastructure. Validation data was collected on 39 primary care clinics. Content validity, inter-rater reliability, internal consistency, and construct validity of the 49-item instrument were assessed. Inter-rater agreement indices per item ranged from 0.50 to 1.0. Cronbach's alpha of the entire instrument was 0.964, and for the five domain scales ranged from 0.688 to 0.961. Clinics with existing care coordinators were rated as more ready to support care coordination than clinics without care coordinators for the entire DCCRA and for each domain, supporting construct validity. As providers increasingly attempt to adopt patient-centered approaches, introduction of the DCCRA is timely and appropriate for assisting clinics with identifying gaps in provision of care coordination services. The DCCRA's strengths include promising psychometric properties. A valid measure of diabetes care coordination readiness should be useful in diabetes program evaluation, assistance with quality improvement initiatives, and measurement of patient-centered care in research.

Patient-centered care: the influence of patient and resident physician gender and gender concordance in primary care.

Patient-centered care (PCC) is thought to significantly influence the process of care and its outcomes and has been identified as part of a comprehensive strategy for improving our nation's healthcare delivery system. Patient and physician gender, as well as gender concordance, may influence the provision of PCC. Patients (315 women, 194 men) were randomized to care by primary care resident physicians (48 women, 57 men). Sociodemographic information, history of health risk behaviors (tobacco use, alcoholism, and obesity), and self-reported global pain and health status were collected before the first visit. That visit and subsequent patient visits to the primary care physician (PCP) were videotaped during the year-long study period. PCC was measured by coding all videotapes using a modified version of the Davis Observation Code. No significant gender differences in PCC were found between the male and female patients; however, female physicians provided increased PCC to their patients. The greatest amount of PCC was seen in the female patient-female physician gender dyad. Regression analyses, controlling for other patient variables, confirmed that female concordant dyads were associated with a greater amount of PCC. There was no significant relationship for the male patient-male physician concordance (vs. disconcordance). These findings highlight the influence of gender in the process of care and provision of PCC. Gender concordance in female patient-female physician dyads demonstrated significantly more PCC. Further research in other clinical settings using other measures of PCC is needed. A public mandate to provide care that is patient-centered has implications for medical education.

Patient‐centered care and adherence: Definitions and applications to improve outcomes

The implementation of patient-centered care (PCC) has been hampered by the lack of a clear definition and method of measurement. The purpose of this review is to identify the fundamental characteristics of PCC to clarify its definition, propose a method for measurement of PCC, and recommend effective PCC practices. Review of literature related to PCC, adherence and communication from Cinahl, PubMed Academic Search Premier, and Cochrane Library databases. Research has shown that patient-centered interactions promote adherence and lead to improved health outcomes. The fundamental characteristics of PCC were identified as (a) patient involvement in care and (b) the individualization of patient care. The use of a numeric rating scale to measure the presence of these characteristics allows quantification from the patient perspective. Effective PCC practices were related to communication, shared decision making, and patient education. PCC is a measure of the quality of health care. Understanding the characteristics of PCC facilitates its implementation and measurement. Promoting PCC activities will improve adherence and encourage patient responsibility for health status.

Development and Testing of the Multidimensional Trust in Health Care Systems Scale

To describe the development and psychometric testing of the Multidimensional Trust in Health Care Systems Scale (MTHCSS). Scale development occurred in 2 phases. In phase 1, a pilot instrument with 70 items was generated from the review of the trust literature, focus groups, and expert opinion. The 70 items were pilot tested in a sample of 256 students. Exploratory factor analysis was used to derive an orthogonal set of correlated factors. In phase 2, the final scale was administered to 301 primary care patients to assess reliability and validity. Phase 2 participants also completed validated measures of patient-centered care, health locus of control, medication nonadherence, social support, and patient satisfaction. In phase 1, a 17-item scale (MTHCSS) was developed with 10 items measuring trust in health care providers, 4 items measuring trust in health care payers, and 3 items measuring trust in health care institutions. In phase 2, the 17-item MTHCSS had a mean score of 63.0 (SD 8.8); the provider subscale had a mean of 40.0 (SD 6.2); the payers subscale had a mean of 12.8 (SD 3.0); and the institutions subscale had a mean of 10.3 (SD 2.1). Cronbach's alpha for the MTHCSS was 0.89 and 0.92, 0.74, and 0.64 for the 3 subscales. The MTHCSS was significantly correlated with patient-centered care (r = .22 to .62), locus of control-chance (r = .42), medication nonadherence (r = -.22), social support (r = .25), and patient satisfaction (r = .67). The MTHCSS is a valid and reliable instrument for measuring the 3 objects of trust in health care and is correlated with patient-level health outcomes.

Information provision, patient involvement, and emotional support: prospective areas for improving anesthetic care.

To explore patients' perceptions of anesthetic care as measured by a patient-centered care survey. Specifically, the survey examined patient views of multiple diverse dimensions of care that are not typically fully addressed among patients receiving anesthesia services, namely opinions on Information Provision, Involvement in Care, Respect Shown, Physical Comfort, and Emotional Support. A total of 268 patients responded to a patient-centered care survey, a self-report factor analytically derived instrument designed to measure the aforementioned dimensions of care. Analyses revealed that the highest ratings of care were given to Physical Comfort and Respect. Ratings of Information Provision, Involvement, and Emotional Support were significantly lower. Ratings did not differ as a function of site of service, inpatient vs day surgery, surgical service, type of anesthetic, or anesthesiologist. The findings generated from the study are of value in obtaining a broader understanding of anesthesia services from the patient's perspective, and also in directing quality improvement initiatives. Other departments of anesthesiology interested in quality improvement initiatives may similarly benefit from measurement of patient-centered care.