PERCEPTION OF PATIENT-PROVIDER COMMUNICATION AND ITS ASSOCIATION WITH HEALTH SERVICES UTILIZATION

Abstract

The Patient Protection and Affordable Care Act of 2010 has generated an unprecedented emphasis on patient satisfaction and patient-centered care. This dissertation is composed of a series of papers on how patients perceive the quality of care delivered by their healthcare providers and its relationship to their usage of health services. The main hypothesis is that higher perceived quality of care is associated with more effective use of health services. The studies use nationally representative data from the Medical Expenditure Panel Survey (MEPS) with the research grounded in Andersen's Behavioral Model of Health Services Use. In the first study, I explore whether differences in satisfaction between English- and Spanish-speaking Hispanics can be explained by acculturation and concordance with their providers with regard to race, ethnicity, gender, and language. I use the econometric Blinder-Oaxaca decomposition method to quantify the contributions of each measured characteristic for explaining disparities in patient satisfaction. In the second study, I examine whether a lack of patient-centeredness and poor access to a regular provider are associated with greater nonemergent emergency department (ED) utilization. I employ a hurdle model to account for the two-part decision making process of whether to use the ED and how often to use the ED for nonemergent purposes. In the third study, I investigate the relationship between patient-centered care and receipt of six recommended clinical preventive services including screening for breast cancer, cervical cancer, colorectal cancer, high cholesterol, hypertension, and vaccination against influenza. I use multivariate logistic regression models to determine the probability of compliance with national prevention guidelines. The results reveal the importance of how patients perceive interpersonal communication with their healthcare providers. In the first study, acculturation is implicated as a major contributor to differences in patient satisfaction with communication. Furthermore, the results from the second study indicate language concordance between patients and providers is related to less nonemergent ED use. Findings from the third study suggest a pattern of greater compliance with clinical preventive service recommendations when patients perceive receiving patient-centered care from their providers. Implications for policy and practice are presented.