상세정보
Export to Refworks부가기능
The Role of the Physician-Patient Relationship in Patient Outcomes
상세 프로파일
| 자료유형 | 학위논문 |
|---|---|
| 서명/저자사항 | The Role of the Physician-Patient Relationship in Patient Outcomes. |
| 개인저자 | Staiger, Rebecca Lynn. |
| 단체저자명 | Yale University. Public Health. |
| 발행사항 | [S.l.]: Yale University., 2019. |
| 발행사항 | Ann Arbor: ProQuest Dissertations & Theses, 2019. |
| 형태사항 | 138 p. |
| 기본자료 저록 | Dissertations Abstracts International 81-03A. Dissertation Abstract International |
| ISBN | 9781088316429 |
| 학위논문주기 | Thesis (Ph.D.)--Yale University, 2019. |
| 일반주기 |
Source: Dissertations Abstracts International, Volume: 81-03, Section: A.
Advisor: Schlesinger, Mark. |
| 이용제한사항 | This item must not be sold to any third party vendors. |
| 요약 | The physician-patient relationship has long been believed to be a cornerstone of high-value healthcare. However, our ability to determine what a "good" relationship looks like, or when and for whom relationships most matter, has been restricted conceptually by overly simplistic "one-size-fits-all" assumptions such as the ubiquitous importance of relational continuity, and empirically by data limitations and study design that impede causal assessment. Such conceptual and empirical restrictions have limited the ability of prior research to sufficiently measure the importance of relationships in healthcare settings, including the assessment of disruptions to and suboptimal construction of these relationships. At the same time, many studies have documented persistently low uptake of recommended preventive care, inadequate adherence to prescribed treatments, and non-negligible incidences of preventable hospitalizations despite apparent clinician care. While these patterns may be symptomatic of a variety of structural and functional challenges in our current healthcare delivery systems, they are also indicative of suboptimally functioning relationships.This thesis seeks to begin filling in the gaps in our understanding of how, when, and for whom physician-patient relationships are important. In a departure from the current literature, I do not assume that continuity in the relationship is a universally positive attribute, and instead consider the importance of relational continuity-and the relationship itself-to vary as a function of particular patient characteristics and needs, as well as provider skill in cultivating productive relationships. In other words, I propose that some patients will benefit from strong, continuous relationships more than others, while clinician expertise in building such relationships can similarly differ.Building on these insights, I develop a model to estimate the importance of the physician-patient relationship as a function of patient and physician characteristics. I test this model in Medicaid managed care settings, focusing on enrollees with a new diagnosis of a chronic condition, as a population that is arguably most sensitive to relationships with their physicians. Following a physician's exit from a patient's managed care network, I test for effects of a disrupted relationship on patient utilization and wellbeing, focusing on outcomes that have been shown to respond to the quality of preventive care a patient receives. I find a significant decrease in office visits post-exit, but no impact on preventive-care sensitive health events. Notably, I do not control for the fit of the relationship itself. I then use insights from the economics of matching, along with basic demographic and utilization information in administrative data, to develop a model of patient and physician coproduction of health that aims to inform the creation of optimal provider-patient relationships based on unobserved (latent) characteristics in both clinicians and patients. I estimate the effect of the physician-patient relationship on health outcomes, finding a significant effect of the composition of the provider-patient relationship on adverse health events.I then incorporate these findings into my model of the coproduction of health, where I demonstrate that sorting patients to providers in a systematic way based on observable attributes (to model these latent effects) could reduce avoidable hospitalizations. I compare predicted health outcomes from existing matches to the predicted health outcomes produced by the systematic re-matching suggested by my model, and find an average decrease of 26% in avoidable hospitalizations. Conservative back-of-the-envelope calculations suggests that this translates to $270 million in potential annual savings in hospital costs alone. Using this model of relationship fit, I re-estimate the impact of disruptions to provider-patient relationships, controlling for fit, and find that effects on office visits are twice as large among "good" disrupted relationships. However, I find little to no evidence of an impact on adverse health events.These findings suggest that a more systematic understanding of relationships, even one based on simple demographic information, has the potential to improve health and reduce avoidable spending, and to advance our ability to thoughtfully evaluate certain healthcare delivery conventions. While additional inputs (patient, physician, system-level) to the matching model might improve the precision of suggested matches, the current model has the advantage of being readily operationalized with existing administrative information. As such, it is accessible for public policy and health system administrators to implement as a potentially low-cost, straight-forward method to improve health outcomes. |
| 일반주제명 | Public health. Economics. |
| 언어 | 영어 |
| 바로가기 | 
: 이 자료의 원문은 한국교육학술정보원에서 제공합니다. |
