SAN DIEGO – Inpatients who most strongly preferred to leave medical decisions to their doctors were discharged a third of a day sooner with $970 lower mean costs per patient, compared with patients who strongly disagreed about leaving decisions to their physicians, a study of data on 20,213 patients found.
The findings throw a wrinkle into the idea that empowering patients for shared decision making is always the best approach, Hyo Jung Tak, Ph.D. said at the annual meeting of the Society of Hospital Medicine.
Hyo Jung Tak, Ph.D.: "In our study, it was patients with higher education and with more general health insurance who preferred to participate" in decision-making."
Administrative and patient interview data on patients in the general medicine service at the University of Chicago Medical Center from 2003-2011 included responses of to the statement, "I prefer to leave decisions about my medical care up to my doctor." Patients responded with "definitely agree" (37% of patients), "somewhat agree" (34%), "somewhat disagree" (15%), or "definitely disagree" (14%).
Although 96% of patients said that they prefer to be informed by their doctors about treatment options and to be asked their opinions, 71% of patients strongly or somewhat agreed that they prefer to leave decisions about medical care to their doctors.
Dr. Tak compared responses to data on patients’ health care utilization, length of stay, and mean total costs.
Length of stay averaged 5.3 days for the entire cohort, but patients who "definitely agreed" with letting doctors make decisions left the hospital 0.31 days sooner than did those who "definitely disagreed," reported Dr. Tak and her associate in the study, Dr. David Meltzer, both of the University.
Total costs averaged $14,500 for the entire cohort, but costs for patients who "definitely agreed" with leaving decision to doctors averaged $970 less than for patients who "definitely disagreed" with that approach.
The differences between groups in length of stay and cost were statistically significant, Dr. Tak said. The analysis controlled for the possible effects of age, gender, educational category, health status, 10 most frequent diagnoses, Charlson index, weekend admission, transfer from another institution, and attending physicians.
The results raise a provocative question, she said: "Will patient empowerment efforts in a shared-decision model increase costs" in an era in which cost-control is one of the most pressing health policy issues?
Patients who definitely agreed to leave medical decisions to their doctors were significantly more likely to have no more than a high school education and to have public or no insurance, compared with patients who definitely disagreed about leaving medical decisions to their doctors.
Shared decision making between doctors and patients has emerged as the preferred approach for medical decisions, but patient preference for this approach has not been well characterized, and the effects of this approach on medical resource utilization rarely have been studied, Dr. Tak said.
The study was limited by its reliance on data from a single institution and by a lack of information on physicians’ preferences for shared decision making and the decision-making mechanisms.
The investigators plan further studies on how preferences for shared decision making affect health outcomes and on associations between socioeconomic status and preferences about decision-making. "At least in our study, it was patients with higher education and with more generous health insurance who preferred to participate" in decision-making, she said.
Dr. Tak reported having no financial disclosures.