Patients with a higher level of education, more access to medical information, and generous health insurance coverage may be more likely to participate in their medical decision making process. However, few studies directly measure what proportion of patients prefers to leave decisions about medical care up to their doctor. Further, very few studies provide empirical evidence of whether patient preference or intention to participate in medical care decisions actually influences medical care outcomes, especially among hospitalized patients. As medical care during hospitalization is often complex, understanding the effect of patientphysician medical care decision sharing could provide valuable information to hospital medicine physicians.
We utilized data collected through a MultiCenter Trial of Academic Hospitalists at University of Chicago Medical Center. The applicable sample population includes 20,859 patients who were hospitalized between July 2004 and the present and who participated in the inpatient survey. The dependent variables are hospital length of stay and total medical care cost. The key independent variable is patient preference regarding the level of involvement in the medical care decisionmaking process. We constructed binary category of survey responses to the statement “I prefer to leave decisions about my medical care up to my doctor” (= 1 if somewhat agree or definitely agree, = 0 if somewhat disagree or definitely disagree). We also controlled for demographic, several health status variables, education categories, insurance status, transfer from other place, weekend admission, dummies for year, month, and attendings. As the dependent variables are skewed to the right and have outliers, we estimated them using a generalized linear model with log link and gamma family.
On average, patient length of stay in the hospital was 5.37 days and the total medical care cost was $14,527. Approximately 70.9% of patients prefers to leave decision making about medical care up to the doctor (37.6% definitely agree, 33.3% somewhat agree). The estimation results suggest that patient length of stay is shorter by 0.18 days (95% C.I. = [0.35, 0.008], pvalue = 0.040) and the total cost is reduced by $572 (95% C.I. = [1173, 28], pvalue = 0.062) when a patient prefers to leave decisions about medical care up to the doctor.
Patient preference to participate in the medical care decisionmaking process has a statistically significant impact on hospital length of stay and total cost. Responsiveness to patient preferences is likely important in improving quality of care and patient satisfaction. However, there may be the potential for adverse effects on costs that also should be considered.
To cite this abstract:Meltzer D, Tak H. Effect of Patient Preference in Medical Decision Making on Inpatient Care. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97634. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/effect-of-patient-preference-in-medical-decision-making-on-inpatient-care/. Accessed July 21, 2019.