title: Patient-centered decision making and health care outcomes: an observational study.
abstract: BACKGROUND
  Patient-centered decision making (PCDM) is the process of identifying clinically relevant, patient-specific circumstances and behaviors to formulate a contextually appropriate care plan.
  
  
  OBJECTIVE
  To ascertain whether encounters in which PCDM occurs are followed by improved health care outcomes compared with encounters where there is inattention to patient context.
  
  
  METHODS
  Patients surreptitiously audio-recorded encounters with their physicians. Medical records of these encounters were then screened for "contextual red flags," such as deteriorating self-management of a chronic condition, that could reflect such underlying contextual factors as competing responsibilities or loss of social support. When a contextual factor was identified, either as a result of physician questioning or because a patient volunteered information, physicians were scored on the basis of whether they adapted the care plan to it.
  
  
  METHODS
  Internal medicine clinics at 2 Veterans Affairs facilities.
  
  
  METHODS
  774 patients audio-recorded encounters with 139 resident physicians.
  
  
  METHODS
  Individualized outcome measures were based on the contextual red flag, such as improved blood pressure control in a patient presenting with hypertension and loss of medication coverage. Outcome coders were blinded to physician performance.
  
  
  RESULTS
  Among 548 contextual red flags, 208 contextual factors were confirmed, either when physicians probed or patients volunteered information. Physician attention to contextual factors (both probing for them and addressing them in care plans) varied according to the presenting contextual red flags. Outcome data were available for 157 contextual factors, of which PCDM was found to address 96. Of these, health care outcomes improved in 68 (71%), compared with 28 (46%) of the 61 that were not addressed by PCDM (P = 0.002).
  
  
  CONCLUSIONS
  The extent to which the findings can be generalized to other clinical settings is unknown.
  
  
  CONCLUSIONS
  Attention to patient needs and circumstances when planning care is associated with improved health care outcomes.
  
  
  BACKGROUND
  U.S. Department of Veterans Affairs, Health Services Research & Development Service.
authors.affiliation: University of Illinois at Chicago, 2730 UH MC 103, 601 South Morgan, Chicago, IL 60607-7128, USA. sweiner@uic.edu
authors.forename: Saul J
authors.initials: SJ
authors.lastname: Weiner
authors.forename: Alan
authors.initials: A
authors.lastname: Schwartz
authors.forename: Gunjan
authors.initials: G
authors.lastname: Sharma
authors.forename: Amy
authors.initials: A
authors.lastname: Binns-Calvey
authors.forename: Naomi
authors.initials: N
authors.lastname: Ashley
authors.forename: Brendan
authors.initials: B
authors.lastname: Kelly
authors.forename: Amit
authors.initials: A
authors.lastname: Dayal
authors.forename: Sonal
authors.initials: S
authors.lastname: Patel
authors.forename: Frances M
authors.initials: FM
authors.lastname: Weaver
authors.forename: Ilene
authors.initials: I
authors.lastname: Harris
mesh_terms: D003657:Decision Making; D015438:Health Behavior; D006801:Humans; D007388:Internal Medicine / Q000592:standards; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010347:Patient Care Planning / Q000592:standards*; D010349:Patient Compliance; D010358:Patient Participation; D018802:Patient-Centered Care / Q000592:standards*; D010361:Patients / Q000523:psychology*; D011320:Primary Health Care / Q000592:standards; D012944:Social Support