Satisfaction With Provider Communication In Recent Study Is Lower In Patient Center-Medical Homes (PCMH) Than Non-PCMH

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A recent blog headline on the Patient-Centered Primary Care Collaborative (PCPCC) recently caught my attention.  It was entitled Patient Satisfaction With Medical Home Quality High.  I was intrigued.  I asked myself high compared to what?  Non-PCMH practices?

The study, which appeared in the November-December 2013 Annals of Family Medicine, asked 4,500 patients (2009 Health Center Patient Survey) of federally-support health centers (not all accredited PCMH) their perceptions of a number of “patient-centered quality attributes,” including the following measures which the study authors defined as patient-centered communication:Quotelowbar

  • Clinician staff listened to you?
  • Clinician staff takes enough time with you?
  • Clinician staff explains what you want to know
  • Nurses and MAs answered your questions?
  • Nurses and MAs are friendly and helpful to you?
  • Other staff is friendly and helpful to you?
  • Other staff answered your questions?

 

Observations About The Study

The first thing that struck me was that compared to patients in the 2012 CHAPS survey (AHRQ) website, patients in the 2009 PCMH study actually reported lower levels of 1) patient satisfaction with their clinicians’ patient-centered attributes (including communication) (81% in study versus 91% in CHAPS) and 2) lower in willingness to recommend their providers (84% study versus 89% in CAHPS).

The second thing I was reminded of is that patients themselves are so used to clinicians’ paternalistic, physician-directed communication style that simply allowing them to ask just one question puts the clinician in the top 5% of patient-centered communicators.  Stop and ask yourself when the last time was that you encountered a physician that asked you what you thought about your medical condition?  Until recently I never have been and I suspect few if any people in the study cited here have either.

Stop and ask yourself when the last time was that you encountered a physician that asked you what you thought about your medical condition?

The final thing that struck me was that none of the quality measures used in the study captured the “essential and revolutionary meaning of what it means to be patient-centered.” As health communication experts Street and Epstein point out, patient centered communication is about inviting the patient to get invDont Tripolved in the exam room conversation.

As articulated in hundreds of studies over the years, patient-centered communication skills include:

  • Soliciting the patient’s story
  • Visit agenda setting
  • Understanding the patient’s health perspective
  • Understanding the whole patient (biomedical and psychosocial)
  • Shared decision-making
  • Empathy

 

Nothing remotely close to these skills are included in the 2009 PCMH study.

Could Your Patient Communication Skills Use A Tune Up?  Find Out.  Sign Up For the Adopt One! Challenge. 

It’s Free For  Qualifying Physicians

We Need To Raise The Bar For Patient-Centered Medical Homes (PCMH)

Studies like the one cited here set the quality bar (and bragging rights) way too low for PCMH. Patient-centered care has to be different than the paternalistic, physician-directed care we all seem so willing to accept. Such studies trivialize what it means for physicians and their care teams to be patient-centered in the way they relate to and communicate with people (aka patients). Patient-centeredness is a philosophy or care…and does not require team care, extended hours or care coordinators. These are great added features, but to equate such services with patient-centeredness misses the boat…something which professional groups like the PCPCC, NCQA, Joint Commission, and URAC should recognize by now.

The Take Away?

Here’s some thoughts:

1) We need to set the bar higher for PCMHs when it comes to how we define and measure patient-centered communication.

2) We need to find better ways to asses patient-centered communications in actual practice. Patient rating of a clinician’s patiient-centeredness are simply not enough.  As part of the 2014 Adopt One! Challenge, we will be using audio recording of actual physician-patient exam room conversations to measure and benchmark clinicians’ patient-centered communication skills.

3) We should stop celebrating being average whether it be in PCMH setting or hospitals when it comes to physician-patient communications.

That what I think. What’s your opinion?

Could Your Patient Communication Skills Use A Tune Up?  Find Out.  Sign Up For the Adopt One! Challenge. 

It’s Free For  Qualifying Physicians

Sources:

  • Lebrun-Harris et al.  Effects of Patient-Centered Medical Home Attributes On Patient’s Perception Of Quality In Federaly-Supported Health Centers. Annals of Family Medicine. 2013; 11:6; 508-516.
  • Street et al.  The Value and Values of Patient-Centered Care. Annals of Family Medicine. 2011; 9; 100-103.

3 Comments

  1. Pamela Ballou-Nelson says:

    Please note the 2009 findings for PCMH are based on 2008 and earlier models. The more recent studies are based on 2011 standards and now we are looking at 2014 standards. Keep in mind health care is changing so fast anything a year or two old has changed. You can hardly look at one year ago and say things are the same Your data is almost 5 years old.

    • stwilkins says:

      Pamela,

      Thanks for your comments!

      The article and research referenced in my post is being used to “tout” the progress being made by PCMH by industry press and social media. Based upon the data in the study…such claims are false and give credit where credit is not warranted. The article was published last month. Would newer data based on the same “useless” measures included in the study look better? Perhaps. But what good is useless data?

      The point of my post is that there is nothing patient-centered about the measures used in the study. I shared examples of patient-centered skills which would be more reflective of true patient-centered communications. I would also direct you to another recent post of mine entitle the “Myth of Patient-Centered Care” wher I share the results of more current data to support my point.

      I am not “slamming” PCMH here. I am challenging them to raise the bar and “walk the talk”…that being that if you call your self patient centered you need to be able to prove it starting with how you talk with and relate to patients.

  2. Thanks for this post Steven and thanks for comparing the two reports for us. I am amazed at the free pass PCMH is getting in the literature. At times it resembles a propaganda campaign. The most obvious example is the “In Search of Joy in Practice” paper in the Annals of Family Medicine this year.
    http://annfammed.org/content/11/3/272

    In this “study” – and I use the term very loosely – the authors do two things that should have had this paper thrown out by the journal’s reviewers:

    - automatically define PCMH as a “high-functioning primary care practice” but made no attempt to measure or define “high functioning”

    - Imply that it returns the Joy to medicine for practitioners but don’t ask the docs if that is true for them or measure in any way

    This is essentially an op/ed piece promoting PCMH.

    Here is the biggest challenge to PCMH in my opinion … we don’t teach physicians the leadership skills to run the kinds of cross functional teams this practice structure demands. Every physician in a PCMH has to go through a steep leadership learning curve to do it well. There exists the possibility that it will return “joy” to their practice … and stress and burnout are also possible along the way.

    Thanks again for running the numbers and pointing out where the emperor’s clothes are actually of inferior quality compared to last year.

    Dike
    Dike Drummond MD
    http://www.thehappymd.com

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