Association of patient preferences for participation in decision making with length of stay and costs among hospitalized patients

Hyo Jung Tak, Gregory W. Ruhnke, David O. Meltzer

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

IMPORTANCE: Patient participation in medical decision making has been associated with improved patient satisfaction and health outcomes. However, there is little evidence concerning its effects on resource utilization. Patient participation in medical decision making has been hypothesized to decrease excess utilization but might be expected to increase utilization when other decision makers have incentives to reduce utilization, as under prospective payment systems for hospital care. OBJECTIVE: To examine the relationship between patient preferences for participation in medical decision making and health care utilization among hospitalized patients. DESIGN AND SETTING: Survey study in an academic research setting. PARTICIPANTS: A survey that included questions about preferences to receive medical information and to participate in medical decision making was administered to all patients admitted to the University of Chicago Medical Center general internal medicine service between July 1, 2003, and August 31, 2011, and completed by 21 754 (69.6%) of admitted patients. MAIN OUTCOMES AND MEASURES: The survey data were linked with administrative data, including length of stay and total hospitalization costs.We used generalized linear models to measure the association of patient preference for participation in decision making with length of stay and costs. RESULTS: The mean length of stay was 5.34 days, and the mean hospitalization costs were $14 576. While 96.3%of patients expressed a desire to receive information about their illnesses and treatment options, 71.1% of patients preferred to leave medical decision making to their physician. Preference to participate in decision making increased with educational level and with private health insurance. Compared with patients who had a strong desire to delegate decisions to their physician, patients who preferred to participate in decision making concerning their care had a 0.26-day (95%CI, 0.06-0.47 day) longer length of stay (P = .01) and $865 (95%CI, $155-$1575) higher total hospitalization costs (P = .02). CONCLUSIONS AND RELEVANCE: Patient preference to participate in decision making concerning their care may be associated with increased resource utilization among hospitalized patients. Variation in patient preference to participate in medical decision making and its effects on costs and outcomes in the presence of varying physician incentives deserve further examination.

Original languageEnglish (US)
Pages (from-to)1195-1203
Number of pages9
JournalJAMA Internal Medicine
Volume173
Issue number13
DOIs
StatePublished - Jul 8 2013

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Patient Participation
Patient Preference
Length of Stay
Decision Making
Costs and Cost Analysis
Hospitalization
Physicians
Motivation
Patient Acceptance of Health Care
Prospective Payment System
Health Insurance
Internal Medicine
Patient Satisfaction
Clinical Decision-Making
Linear Models
Health

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Association of patient preferences for participation in decision making with length of stay and costs among hospitalized patients. / Tak, Hyo Jung; Ruhnke, Gregory W.; Meltzer, David O.

In: JAMA Internal Medicine, Vol. 173, No. 13, 08.07.2013, p. 1195-1203.

Research output: Contribution to journalArticle

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abstract = "IMPORTANCE: Patient participation in medical decision making has been associated with improved patient satisfaction and health outcomes. However, there is little evidence concerning its effects on resource utilization. Patient participation in medical decision making has been hypothesized to decrease excess utilization but might be expected to increase utilization when other decision makers have incentives to reduce utilization, as under prospective payment systems for hospital care. OBJECTIVE: To examine the relationship between patient preferences for participation in medical decision making and health care utilization among hospitalized patients. DESIGN AND SETTING: Survey study in an academic research setting. PARTICIPANTS: A survey that included questions about preferences to receive medical information and to participate in medical decision making was administered to all patients admitted to the University of Chicago Medical Center general internal medicine service between July 1, 2003, and August 31, 2011, and completed by 21 754 (69.6{\%}) of admitted patients. MAIN OUTCOMES AND MEASURES: The survey data were linked with administrative data, including length of stay and total hospitalization costs.We used generalized linear models to measure the association of patient preference for participation in decision making with length of stay and costs. RESULTS: The mean length of stay was 5.34 days, and the mean hospitalization costs were $14 576. While 96.3{\%}of patients expressed a desire to receive information about their illnesses and treatment options, 71.1{\%} of patients preferred to leave medical decision making to their physician. Preference to participate in decision making increased with educational level and with private health insurance. Compared with patients who had a strong desire to delegate decisions to their physician, patients who preferred to participate in decision making concerning their care had a 0.26-day (95{\%}CI, 0.06-0.47 day) longer length of stay (P = .01) and $865 (95{\%}CI, $155-$1575) higher total hospitalization costs (P = .02). CONCLUSIONS AND RELEVANCE: Patient preference to participate in decision making concerning their care may be associated with increased resource utilization among hospitalized patients. Variation in patient preference to participate in medical decision making and its effects on costs and outcomes in the presence of varying physician incentives deserve further examination.",
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