Hyo Jung Tak

Association of Patient Preferences for Participation in Decision Making With Length of Stay and Costs Among Hospitalized Patients

IMPORTANCE Patient participation in medical decision making has been associated with improved patient satisfaction and health outcomes. However, there is little evidence concerning its effects on resource utilization. Patient participation in medical decision making has been hypothesized to decrease excess utilization but might be expected to increase utilization when other decision makers have incentives to reduce utilization, as under prospective payment systems for hospital care. OBJECTIVE To examine the relationship between patient preferences for participation in medical decision making and health care utilization among hospitalized patients. DESIGN AND SETTING Survey study in an academic research setting. PARTICIPANTS A survey that included questions about preferences to receive medical information and to participate in medical decision making was administered to all patients admitted to the University of Chicago Medical Center general internal medicine service between July 1, 2003, and August 31, 2011, and completed by 21,754 (69.6%) of admitted patients. MAIN OUTCOMES AND MEASURES The survey data were linked with administrative data, including length of stay and total hospitalization costs. We used generalized linear models to measure the association of patient preference for participation in decision making with length of stay and costs. RESULTS The mean length of stay was 5.34 days, and the mean hospitalization costs were

Racial disparities in reaching the renal transplant waitlist: is geography as important as race?

14,576. While 96.3% of patients expressed a desire to receive information about their illnesses and treatment options, 71.1% of patients preferred to leave medical decision making to their physician. Preference to participate in decision making increased with educational level and with private health insurance. Compared with patients who had a strong desire to delegate decisions to their physician, patients who preferred to participate in decision making concerning their care had a 0.26-day (95% CI, 0.06-0.47 day) longer length of stay (P = .01) and

Association of Intrinsic Motivating Factors and Markers of Physician Well-Being: A National Physician Survey

865 (95% CI,

Quality of Life and Recommendations for Further Care

155-

Social Factors in Childhood and Adulthood Associated with Adult Obesity in African American and White Women

1575) higher total hospitalization costs (P = .02). CONCLUSIONS AND RELEVANCE Patient preference to participate in decision making concerning their care may be associated with increased resource utilization among hospitalized patients. Variation in patient preference to participate in medical decision making and its effects on costs and outcomes in the presence of varying physician incentives deserve further examination.

US Physicians Overwhelmingly Endorse Hospice as the Better Option for Most Patients at the End of Life

In the United States, African Americans and whites differ in access to the deceased donor renal transplant waitlist. The extent to which racial disparities in waitlisting differ between United Network for Organ Sharing (UNOS) regions is understudied.

Exploring the relationship between adverse childhood experiences and oral health-related quality of life: Adverse childhood experiences and oral health-related quality of life

BackgroundAlthough intrinsic motivating factors play important roles in physician well-being and productivity, most studies have focused on extrinsic motivating factors such as salary and work environment.ObjectiveTo examine the association of intrinsic motivators with physicians’ career satisfaction, life satisfaction, and clinical commitment, while accounting for established extrinsic motivators as well.Design and ParticipantsA nationally representative survey of 2000 US physicians, fielded October to December 2011.Main MeasuresOutcome variables were five measures of physician well-being: career satisfaction, life satisfaction, high life meaning, commitment to direct patient care, and commitment to clinical practice. Primary explanatory variables were sense of calling, personally rewarding hours per day, meaningful, long-term relationships with patients, and burnout. Multivariate logit models with survey design provided nationally representative individual-level estimates.Key ResultsAmong 1289 respondents, 85.8% and 86.5% were satisfied with their career and life, respectively; 88.6% had high life meaning; 54.5% and 79.5% intended to retain time in direct patient care and continue clinical practice, respectively. Sense of calling was strongly positively associated with high life meaning (odds ratio [OR] 5.14, 95% confidence interval [95% CI] 2.87–9.19) and commitment to direct patient care (OR 2.50, 95% CI 1.53–4.07). Personally rewarding hours per day were most strongly associated with career satisfaction (OR 5.28, 95% CI 2.72–10.2), life satisfaction (OR 4.46, 95% CI 2.34–8.48), and commitment to clinical practice (OR 3.46, 95% CI 1.87–6.39). Long-term relationships with patients were positively associated with career and life satisfaction and high life meaning. Burnout was strongly negatively associated with all measures of physician well-being.ConclusionsIntrinsic motivators (e.g., calling) were associated with each measure of physician well-being (satisfaction, meaning, and commitment), but extrinsic motivators (e.g., annual income) were not associated with meaning or commitment. Understanding the effects of intrinsic motivators may help inform efforts to support physician well-being.

Physicians’ Religious Characteristics and Their Perceptions of the Psychological Impact of Patient Prayer and Beliefs at the End of Life: A National Survey

Objectives:Physician recommendations for further medical treatment or palliative treatment only at the end of life may influence patient decisions. Little is known about the patient characteristics that affect physician-assessed quality of life or how such assessments are related to subsequent recommendations. Design, Setting, and Subjects:A 2010 mailed survey of practicing U.S. physicians (1,156/1,878 or 62% of eligible physicians responded). Measurements and Main Results:Measures included an end of life vignette with five experimentally varied patient characteristics: setting, alimentation, pain, cognition, and communication. Physicians rated vignette patient quality of life on a scale from 0 to 100 and indicated whether they would recommend continuing full medical treatment or palliative treatment only. Cognitive deficits and alimentation had the greatest impacts on recommendations for further care, but pain and communication were also significant (all p < 0.001). Physicians who recommended continuing full medical treatment rated quality of life three times higher than those recommending palliative treatment only (40.41 vs 12.19; p < 0.01). Religious physicians were more likely to assess quality of life higher and to recommend full medical treatment. Conclusions:Physician judgments about quality of life are highly correlated with recommendations for further care. Patients and family members might consider these biases when negotiating medical decisions.

Taking societal cost into clinical consideration: U.S. physicians’ views

Background. Few studies have examined how individual and neighborhood poverty in childhood and adulthood influence the likelihood of adult obesity. We used a longitudinal cohort to examine these associations. Methods. Our cohort consisted of children born in Baltimore, MD, USA with followup as adults from ages 27 to 33. We used logistic regression to examine the multivariate association between individual and neighborhood poverty in childhood and adulthood and adult obesity, (body mass index ≥30), based on self-reported height and weight. Results. Of the 986 female respondents, 82% were African American and 18% were White. Both groups had similar rates of adulthood obesity (African American 25% versus Whites 26% , 𝑃=0.91), and similar rates of poverty as children and adults. There was no statistically significant association between individual or neighborhood poverty during childhood and the likelihood of adult obesity. Adults at risk for overweight or overweight as children had significantly greater odds of adult obesity (OR 2.8 and 12.1, resp.). Conclusion. In this sample of women with high rates of childhood and adulthood poverty, obesity rates were high. Childhood risk for overweight and overweight were strongly associated with adult obesity. Individual and neighborhood poverty in childhood were not independently associated with adulthood obesity.

Patient-Centered Medical Home Measurement in School-Based Health Centers:

Background: Utilization of hospice has increased significantly over the past 2 decades, but there has been no recent assessment of US physicians’ opinions regarding and practices of referring patients to hospice. Methods: We surveyed 2016 US physicians from various specialties. Respondents agreed or disagreed with 2 statements: “For most patients, hospice provides better care at the end of life than they would otherwise receive without hospice” and “Many patients who enter hospice end up missing out on medical interventions from which they would have benefited.” Physicians were also asked, “In the past 12 months, approximately how many patients and/or their surrogates have you encouraged to consider entering hospice?” Results: Ninety-eight percent of physicians agreed that hospice provides better care at the end of life than the patient would receive without hospice. Only 11% of physicians agreed that patients who enter hospice miss out on medical interventions from which they would have benefitted. Ninety-two percent encouraged at least 1 patient to consider hospice in the previous 12 months. Oncologists were the most ambivalent about whether patients who enter hospice miss out on beneficial interventions, but they also referred more patients to hospice than physicians from other specialties. Conclusion: US physicians overwhelmingly believe hospice is the best form of care for most patients at the end of life. Compared to a study published in 1998, the median oncologist reports referring fewer patients to hospice, but the median general internist reports referring more.