Mortality among patients with acute myocardial infarction: the influences of patient-centered care and evidence-based medicine.
BACKGROUND
Recent studies have suggested that there is a positive impact of patient-centered care (PCC) on both the patient-physician relationship and subsequent patient health-related behaviors. One recent prospective study reported a significant relationship between the degree of PCC experienced by patients during their hospitalization for acute myocardial infarction (AMI) and their postdischarge cardiac symptoms. A limitation of this study, however, was a lack of information regarding the technical quality of the AMI care, which might have explained at least part of the differences in outcomes. The present study was undertaken to test the influence of both PCC and technical care quality on outcomes among AMI patients.


METHODS
We analyzed data from a national sample of 1,858 veterans hospitalized for an initial AMI in a Department of Veterans Affairs medical center during fiscal years 2003 and 2004 for whom data had been compiled on evidence-based treatment and who had also completed a Picker questionnaire assessing perceptions of PCC. Cox proportional hazards models were used to estimate the relationship between PCC and survival 1-year postdischarge, controlling for technical quality of care, patient clinical condition and history, admission process characteristics, and patient sociodemographic characteristics. We hypothesized that better PCC would be associated with a lower probability of death 1-year postdischarge, even after controlling for patient characteristics and the technical quality of care.


RESULTS
Better PCC was associated with a significantly but modestly lower hazard of death over the 1-year study period (hazard ratio 0.992, 95 percent confidence interval 0.986-0.999).


CONCLUSIONS
Providing PCC may result in important clinical benefits, in addition to meeting patient needs and expectations.
Meterko
Mark
M
HSR&D Center for Organization, Leadership & Management Research, VA Boston Healthcare System (152-M), Boston, MA, USA.
Wright
Steven
S
Lin
Hai
H
Lowy
Elliott
E
Cleary
Paul D
PD
D000368:Aged; D001294:Attitude to Health; D019317:Evidence-Based Medicine / Q000458:organization & administration*; D005260:Female; D019538:Health Care Surveys; D006787:Hospitals, Veterans; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008390:Markov Chains; D009010:Monte Carlo Method; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality* / Q000523:psychology / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D018802:Patient-Centered Care / Q000458:organization & administration*; D018024:Peer Review, Health Care; D016016:Proportional Hazards Models; D011787:Quality of Health Care / Q000458:organization & administration*; D011795:Surveys and Questionnaires; D015996:Survival Rate; D014481:United States / Q000453:epidemiology