Effect of Physician-Patient Relationship Change Trajectories on Functional Health Using Survey-Weighted, Covariate-Adjusted, Predicted Marginal Means Among a National Representative Cohort of US Adults With Office Visits in 2 Consecutive Years (n = 3,645, Representative of 83 Million US Adults), 2015-2016
| Relationship | MEPS Cohort n | Functional Health (SF-12) | Cohen Effect Estimate | ||||
|---|---|---|---|---|---|---|---|
| 2015 Mean (SD) | 2016 Mean (SD) | Change Mean (SD) | 95% CI | Effect Estimate | 95% CI | ||
| High → Better | 1,208 | 97.90 (0.58) | 98.94 (0.60) | 1.04 (0.39) | 0.29 to 1.80 | 0.08 | 0.02 to 0.13 |
| High → Same | 444 | 96.33 (0.83) | 94.82 (0.85) | –1.51 (0.64) | –2.76 to –0.27 | –0.11 | –0.21 to 0.02 |
| High → Worse | 197 | 93.68 (1.58) | 89.62 (1.49) | –4.06 (0.88) | –5.78 to –2.32 | –0.33 | –0.47 to –0.02 |
| Low → Better | 1,397 | 97.89 (0.62) | 98.75 (0.61) | 0.86 (0.46) | –0.04 to 1.76 | 0.05 | 0 to 0.10 |
| Low → Same | 293 | 95.22 (0.99) | 93.90 (1.12) | –1.32 (0.78) | –2.85 to 0.21 | –0.10 | –0.21 to 0.02 |
| Low → Worse | 106 | 93.82 (1.66) | 91.39 (2.03) | –2.43 (1.48) | –5.33 to –0.47 | –0.16 | –0.35 to –0.03 |
HC = MEPS Household Component; MEPS = Medical Expenditure Panel Survey; MEPS-PC = MEPS Primary Care measure; SF-12 = 12-Item Short-Form Survey; US = United States.
Notes: Mean response for each factor, adjusted for all known confounders, including age, sex, race/ethnicity, educational attainment, insurance status, multimorbidity, and US region using survey-weighted predicted marginal means. Relationship is operationalized using the MEPS-PC Relationship composite measure and cut into 6 trajectories based on 2015 score (high or low) and 2016 score (better, same, worse). High Relationship score in 2015 denotes ≥ median Relationship score at baseline (69.23), whereas Low Relationship score denotes < the population median Relationship score at baseline. Better in 2016 reflects a 1-year change in Relationship score ≥ 0.5 SD; Worse reflects a 1-year change greater than −0.5 SD, and change in either direction < 0.5 SD d enotes Same. The SD for Relationship in 2015 was 13.35. Statistical difference between 3 of 15 pairwise comparisons using Tukey pairwise multiple comparison procedures (P = .05, not adjusted for multiple testing [Bonferroni]): High→Same and High→Better, High→Worse and High→Better, Low→Better and Low→Worse. Borderline significance (P < .10) for High→Worse and High→Same, Low→Better and High→Same, Low→Same and Low→Better.
Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, Longitudinal Panel (HC-193, 2015-2016) and Medical Conditions (HC-190, 2015).