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Mortality among Patients with Acute Myocardial Infarction: The Influences of Patient-Centered Care and Evidence-Based Medicine

Authors

  • Mark Meterko,

    1. HSR&D Center for Organization, Leadership & Management Research, VA Boston Healthcare System (152-M), Boston, MA
    2. Department of Health Policy & Management, Boston University School of Public Health, Boston, M A
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  • Steven Wright,

    1. VA Office of Quality and Performance, Washington, DC
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  • Hai Lin,

    1. Brown Center for the Study of Children at Risk, Women & Infants Hospital of Rhode Island, Providence, RI
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  • Elliott Lowy,

    1. HSR&D Northwest Center of Excellence, VA Puget Sound Healthcare System, Seattle, WA
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  • Paul D. Cleary

    1. Yale School of Public Health, Yale School of Medicine, 60 College Street, LEPH 210, PO Box 208034, New Haven, CT 06520-8034
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    • Address correspondence to Paul D. Cleary, Ph.D., Yale School of Public Health, Yale School of Medicine, 60 College Street, LEPH 210, PO Box 208034, New Haven, CT 06520-8034; e-mail paul.cleary@yale.edu. Mark Meterko, Ph.D., is with the HSR&D Center for Organization, Leadership & Management Research, VA Boston Healthcare System (152-M), Boston, MA. Mark Meterko, Ph.D., is also with the Department of Health Policy & Management, Boston University School of Public Health, Boston, MA. Steven Wright, Ph.D., is with the VA Office of Quality and Performance, Washington, DC. Hai Lin, M.D., M.P.H., is with the Brown Center for the Study of Children at Risk, Women & Infants Hospital of Rhode Island, Providence, RI. Elliott Lowy, Ph.D., is with the HSR&D Northwest Center of Excellence, VA Puget Sound Healthcare System, Seattle, WA.


Abstract

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.

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