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Does patient-centered care improve provision of preventive services?

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Abstract

OBJECTIVES: While patient-centered care (PCC) is desirable for many reasons, its relationship to treatment outcomes is controversial. We evaluated the relationship between PCC and the provision of preventive services.

METHODS: We obtained facility-level estimates of how well each VA hospital provided PCC from the 1999 ambulatory Veterans Satisfaction Survey. PCC delivery was measured by the average percentage of responses per facility indicating satisfactory performance from items in 8 PCC domains: access, incorporating patient preferences, patient education, emotional support, visit coordination, overall coordination of care, continuity, and courtesy. Additional predictors included patient population and facility characteristics. Our outcome was a previously validated hospital-level benchmarking score describing facility-level performance across 12 U.S. Preventive Services Task Force-recommended interventions, using the 1999 Veterans Health Survey.

RESULTS: Facility-level delivery of preventive services ranged from an overall mean of 90% compliance for influenza vaccinations to 18% for screening for seat belt use. Mean overall PCC scores ranged from excellent (>90% for the continuity of care and courtesy of care PCC domains) to modest (<70% for patient education). Correlates of better preventive service delivery included how often patients were able to discuss their concerns with their provider, the percent of visits at which patients saw their usual provider, and the percent of patients receiving >90% of care from a VA hospital.

CONCLUSION: Improved communication between patients and providers, and continuity of care are associated with increased provision of preventive services, while other aspects of PCC are not strongly related to delivery of preventive services.

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Author information

Authors and Affiliations

  1. the Iowa City Veterans Affairs Medical Center, University of Iowa, Iowa City, Iowa

    Stephen D. Flach MD, PhD & Bonnie J. BootsMiller PhD

  2. Public Policy Center, University of Iowa, Iowa City, Iowa

    Stephen D. Flach MD, PhD

  3. Roudebush Veterans Affairs Medical Center, Indianapolis, Ind

    Kimberly D. McCoy MS & Bradley N. Doebbeling MD, MSc

  4. University of Iowa College of Public Health, Iowa City, Iowa

    Thomas E. Vaughn PhD & Marcia M. Ward PhD

  5. Department of Internal Medicine, SE 629 GH, University of Iowa College of Medicine, 200 Hawkins Drive, 52242, Iowa City, IA

    Stephen D. Flach MD, PhD

  6. Indiana University School of Medicine, Indianapolis, Ind

    Bradley N. Doebbeling MD, MSc

  7. Regenstrief Institute for Health Care, Indianapolis, Ind

    Bradley N. Doebbeling MD, MSc

Authors
  1. Stephen D. Flach MD, PhD
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  2. Kimberly D. McCoy MS
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  3. Thomas E. Vaughn PhD
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  4. Marcia M. Ward PhD
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  5. Bonnie J. BootsMiller PhD
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  6. Bradley N. Doebbeling MD, MSc
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Corresponding author

Correspondence to Stephen D. Flach MD, PhD.

Additional information

The research reported here was supported by the Department of Veterans Affairs, the Veterans Health Administration, Health Services Research and Development Service, Investigator Initiated Research grants CPI 99-126 and CPI 01-141, and the VA Quality Enhancement Research Initiative.

Dr. Flach is a staff physician and HSR&D Career Development Award recipient at the Iowa City VAMC. Dr. Doebbeling is principal investigator for this grant, staff physician, and director of the Research Enhancement Award Program in Health Services Research at the Roudebush Veterans Affairs Medical Center, Indianapolis, Ind.

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Flach, S.D., McCoy, K.D., Vaughn, T.E. et al. Does patient-centered care improve provision of preventive services?. J GEN INTERN MED 19, 1019–1026 (2004). https://doi.org/10.1111/j.1525-1497.2004.30395.x

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  • DOI: https://doi.org/10.1111/j.1525-1497.2004.30395.x

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