Date of Award

2016

Document Type

Open Access Dissertation

Department

Health Services and Policy Management

Sub-Department

The Norman J. Arnold School of Public Health

First Advisor

Rajendra Singh

Abstract

Introduction: Patient-centered care is a major focus of healthcare organizations, policy makers, and researchers. Patient-centered communication by the provider and patient engagement are important components of patient-centered care. Despite increasing attention to these topics, we do not fully understand how patient-centered communication and patient engagement relate to perceived quality of care as reported by patients. This study takes some initial steps in exploring these relationships. The study also identifies patient-related factors such as sociodemographic, health-related, and health system factors that are associated with patient-centered communication, patient engagement, and perceived quality of care.

Method: This study used survey data from the 2013 Health Information National Trends Survey (HINTS), conducted from September to December 2013. The study population included non-institutionalized adults over 18 years of age who responded to all questions related to patient-centered communication, patient engagement, and perceived quality of care. A structured equation modeling analysis and a multivariate linear regression analysis were performed to analyze the weighted data.

Results: This study found that patient-centered communication was positively associated with patient engagement (β = 0.29, p < .001) which was, in turn, positively associated with perceived quality of care (β = 0.06, p < .01). Further, patient-centered communication was directly associated with perceived quality of care (β = 0.71, p < .001). Further, indirect relationship was found between patient-centered communication and perceived quality of care, with patient engagement mediating the relationship (β = 0.01, p= 0.012). In addition, compared to those aged 18-34 years old, individuals over 65 years were more likely to report having better patient-centered communication (β = 1.56, p < .001), better patient engagement (β = 1.46, p < .000), and better perceived quality of care (β = 1.46, p = .002). Compared to Non-Hispanic white respondents, Asian respondents reported having worse patient-centered communication (β = - 2.30, p < .001), worse patient engagement (β = - 1.09, p < .05), and worse quality of care (β = - 0.45, p < .001). Further, those who had a regular provider reported better patient-centered communication (β =0.93, p < .01) and better perceived quality of care (β = 0.22, p < .001) compared to their counterparts.

Conclusions: Patient engagement played an important role in the relationship between patient-centered communication and perceived quality of care. Moreover, the patient-related factors such as age, race/ethnicity, and having a regular provider were significant factors in patient-centered communication, patient engagement, and perceived quality of care. These findings can provide guidance to healthcare organizations on designing effective interventions towards patient-centered care.

Available for download on Wednesday, December 12, 2018

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