Does patient-centered care pay off?

Hospitals have adopted patient-centered practices that focus on patients' needs, values, and preferences in hopes of improving quality and controlling costs. Patient-centered practices are intended to involve patients in treatment decisions, increase communication between patients and care-givers, and increase interaction with family members and friends. Rapid adoption of these practices has occurred, even though little is known about the effects of patient-centered care on outcomes and cost.

A simultaneous equations regression model was developed to examine the reciprocal relationships between patient-centeredness, outcomes, and cost. A consortium of employers obtained data from 52 hospital units in southeastern Michigan. Two hundred randomly selected patients were sampled from all discharges on the medical, surgical, and obstetric units at each hospital for the first three months of 1997; the patients were sent the survey in May. Patient-centeredness was measured by patient reports of whether key clinical events occurred (The Picker Inpatient Survey). Outcomes were assessed by rates of unexpected mortality and complications. Cost was defined by self-insured purchaser payments.

Hospital units that were more patient centered were associated with statistically significantly better outcomes and higher costs than those that were less patient centered. The joint relations between outcomes and cost were insignificant.

Patient-centeredness was associated with better outcomes and higher cost. For either the short run or long run, managers, patients, and purchasers should determine whether the improvement in outcomes and patient satisfaction associated with becoming patient centered is worth the investment in costs.