The Influence of Patient-Centeredness on Asian Patients’ Satisfaction, Likelihood to Recommend, and Ratings of Qualit

1. The Influence of Patient-Centeredness on Asian Patients’ Satisfaction, Likelihood to Recommend, and Ratings of Quality Stephen J. Aragon AMERICAN SOCIETY OF BUSINESS AND BEHAVIORAL SCIENCES 18th ANNUAL MEETING, LAS VEGAS, NEVADA FE2BRUARY 24-27, 2011

2. Non-Conflict of Interest Certification The research upon which this presentation is based was sponsored by The National Institutes of Health National and Center on Minority Health and Health Disparities through The Provider Patient-Centeredness and Disparities Outcome Measurement Initiative (NIH/NCMHD-1P20MD002303-04). I certify that neither I nor any member of my family has a material financial relationship, bias or ethical conflict, which will prevent me from making this presentation solely on the basis of its merits. Stephen J. Aragon, PhD, MHA Principal Investigator 2

3. Presentation The Grant The Underlying Theory Some empirical evidence supporting patient-centeredness’ influence on outcomes Closing comments and answer questions 3

4. The Provider Patient-Centeredness and Disparities Outcome Measurement Initiative (NIH/NCMHD-1P20MD002303-04)

5. The Provider Patient-Centeredness and Disparities Outcome Measurement Initiative 5-year $700,000 grant funding empirical research, which will be translated into outcomes to help improve quality and reduce disparities for minority patients, women, and children 5

6. Specific Aims Establish that patient-centeredness is an underlying ability of healthcare providers Establish that the patient-centeredness of health providers affects the outcomes of minority patients, women, and children Establish that the effect of provider patient-centeredness on outcomes is stable across patients, providers, and settings 6

7. Specific Aims Develop a patient-centeredness graduate course for medical, nursing, and allied health students Develop a patient-centeredness certificate program for health providers Develop an inventory for measuring the patient-centeredness of health providers Increase the number of minority researchers involved in patient-centeredness research Conduct annual patient-centeredness symposiums 7

8. The Primary Provider TheoryAn evidence-based generalizable theory of how the patient-centeredness of health providers affects desired outcomes

9. The Primary Provider Theory Developed from observations and interviews with patients in hospitals and medical practices It is exclusively based on principles that favor patients in healthcare encounters 9

10. Theory Principles Clinical competency is a necessary but insufficient condition of desired health outcomes. Desired outcomes require more than clinical competency alone, because delivery of medical care requires interaction with patients. The sourceof patient-centered care is patient-centered providers, not proclamations, policies, or procedures. 10

11. Theory Principles Patient-centeredness is the ability of health providers that affects the quality of their interaction with patients. Providers are solely responsible for the quality of their interaction with their patients. Patients and their families value both the patient-centeredness and clinical competency of providers. Providers who are patient-centered and clinically competent are more likely to achieve desired outcomes. 11

12. Theory Principles Healthcare providers must, above all else, protect the best interests of their patients first. The patient-centeredness of healthcare providers is more important than profit in any single health encounter. Patients are the best judges of the patient-centeredness of their providers. 12

13. High Empathetic, communicative, interested in patient’s feelings Tactful, skilled in relationships with patients Grasp patients’ needs, preferences, values, and concerns Protect patient’s best interests above all else Earn patients’ trust, satisfaction, confidence, high ratings, loyalty Low Aloof, uncommunicative, less interested in patient’s feelings Less tactful and skilled in relationships with patients Less concerned with patient’s needs, preferences, values, and concerns Subordinate patient’s best interests to other interests Tend not to earn patients’ trust, satisfaction, confidence, high ratings, loyalty Patient-Centeredness IQ *Note: High patient-centeredness ability reflects emotional stability, agreeableness, conscientiousness, ethical behavior, interpersonal sensitivity, while low ability reflects more dysfunctional dispositions or relationship derailers, e.g., moody, inconsistent, cynical, distrustful, indifferent, prejudices, critical of others, etc., and personality disorders.

14. The Primary Provider Theory Patient Centerednessof Provider Patient Centerednessof Waiting effect effect effect Patient Outcomes Patient Centerednessof Associates effect effect

15. Empirical EvidenceSupporting the hypothesis that patient-centeredness is an ability of healthcare providers that affects the quality of their interaction with patients and related outcomes

16. Does Pediatric Patient-Centeredness Affect Family Trust? Aragon, S. J., McGuinn, L., Bavin, S. A. and Gesell, S. B., Does Pediatric Patient-Centeredness Affect Family Trust? Journal for Healthcare Quality, 32: 23–31, May/June 2010. http://onlinelibrary.wiley.com/doi/10.1111/j.1945-1474.2010.00092.x/full

17. Theory Sub-Proposition 17

18. Theory Sub-Proposition 18

19. Research Questions Does nursing patient-centeredness affect Medicaid patient satisfaction? If yes, how much? Is the influence of patient-centeredness stable across samples? 19

20. Measures Nursing Patient-Centeredness N1 Friendliness and courtesy N5 Kept patient informed N3 Attitude toward requests N4 Amount of attention 20

21. Measures Medicaid Patient Satisfaction 03 Likelihood of recommending hospital 04 Overall rating of care 21

22. Samples Random samples Total N = 605 Group 1, N = 294 Group 2, N = 311 22

23. Results (standardized) The model fit. Pediatric physician patient-centeredness significantly affected (.95) family trust.1, 2 It explained 89% of family trust.1 2 = 64.87, df = 69, p = .619; RMSEA = .000, p = 1.00; CFI = 1.00; R2 = .89 p < .001 23

24. Results (standardized) The effect was stable across both samples.3,4 The model held versus the competing model.4 Gender had no significant effect on family trust.5 p < .001 2 = 13.94, df = 17, p = .671 P > .62 24

25. Conclusion The patient-centeredness of pediatricians significantly positively influenced their (1) care behaviors with patients and (2) increased family trust, confidence, and the likelihood to recommend the pediatrician to others by .946, .904, and .863 across both samples. 25

26. Closing Comments

27. Closing • DHHS established the reality of wide-spread health disparities the first National Healthcare Disparities Report almost 40 years ago. • The most recent Report states "disparities related to race, ethnicity, and economic status still pervade the American health care system." • Somehow all the science and technology, splendid hospitals, prestigious medical schools and board certified physicians are not enough. Something clinical competency is needed.

28. Closing • Patient-Centeredness is the ability of healthcare providers that affects the quality of their interaction with patients and related outcomes. • Patient-Centeredness is a measurable, teachable, and can improve quality and outcomes. • The Primary Provider Theory is an evidence-based measurement model for designing patient-centeredness outcome studies.

29. Closing • The Theory’s robustness and stability established across: • Patients - African American and Black, American Indian and Alaskan Native, Asian, family practice, cardiology, dental, obstetrical, medical, surgical, emergency, across gender, time, age, and insurance type • Providers - physicians, nurses, mid-level practitioners, and dentists • Settings - hospitals, medical practices, clinics, and emergency departments

30. Thank you!

31. Grant’s Significance Offers another path to help prevent and overcome disparities. Provides empirical evidence that the patient-centeredness of providers affects desired outcomes for minority patients, women, and children. Will establish the yard stick for measuring the patient-centeredness of providers for assessment, selection, and training to improve quality. 31

32. Significance Will help increase the number of minority patient-centeredness researchers. Can help increase the number of patient-centered providers over time. 32

33. Empirical Investigations How the patient-centeredness of obstetrical nurses affects the satisfaction of Medicaid OB patients How the patient-centeredness of physicians and nurses affects the satisfaction of Black and African American female medical, obstetrical, and surgical inpatients How physician and nursing patient-centeredness affects male American Indian and Alaskan Native patient satisfaction, likelihood to recommend, and ratings of care 33

34. Empirical Investigations How nursing patient-centeredness affects the satisfaction of Black and African American female Medicare patients’ satisfaction How the patient-centeredness of physicians affects Asian patient satisfaction, likelihood of recommending the hospital, and ratings of care How the patient-centeredness of nurse practitioners affects patient trust, confidence and likelihood to recommend across national random samples of pediatric, internal medicine and family practice patients 34

35. Empirical Investigations How the patient-centeredness of cardiovascular physicians affects patient trust, confidence, and loyalty How the patient-centeredness of nurse practitioners, waiting time, and nursing affects the likelihood to return of female family practice patients How the patient-centeredness of pediatricians affects family trust, confidence, and likelihood to recommend the pediatrician 35