Patient-centered care and emergency department utilization: a path analysis of the mediating effects of care coordination and delays in care.
Increased emergency department (ED) overcrowding has renewed interest in identifying remedies for unnecessary ED utilization. One potential remedy receiving more attention is patient-centered care. Relatively little is known, however, about how patient-centered care might decrease ED utilization. This study examined two mediating processes by which four dimensions of patient-centered care may affect patients' reported ED visits. Cross-sectional path analysis of 8,140 chronically ill patients found that patients reporting higher levels of patient-centered care were less likely to have experienced problems of care coordination, and in turn were associated with decreased likelihood of having delayed care and fewer ED visits. These findings suggest that understanding how care is delivered, and not simply whether it is available or provided, is an important consideration in understanding ED utilization. Our findings suggest that fostering more fair and respectful relationships between patients and providers may be a particularly important way of reducing ED utilization.
Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, 1530 3rd Avenue S, Birmingham, AL 35294, USA. lhearld@uab.edu
Larry R
LR
Hearld
Jeffrey A
JA
Alexander
D003430:Cross-Sectional Studies; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006300:Health Services Misuse / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care / Q000592:standards*