Patient Participation In Decision Making Associated With Increased Costs, Services

A survey of almost 22,000 admitted patients at the University of Chicago Medical Center found patient preference to participate in decision making concerning their care was associated with a longer length of stay and higher total hospitalization costs, according to a report published online by JAMA Internal Medicine.

Hyo Jung Tak, Ph.D., and colleagues examined the relationship between patient preferences for participation in medical decision making and health care utilization among patients hospitalized between July 1, 2003 and August 31, 2011 by asking patients to complete a survey. The survey data were then linked with administrative data, including length of stay and total hospitalization costs. Nearly all of the patients indicated they wanted information about their illnesses and treatment options, but just over 70 percent preferred to leave the medical decisions to their physician. “Preference to participate in medical decision making increased with educational level and with private health insurance,” the authors note. ““¦patients who preferred to participate in decision making concerning their care had a 0.26-day longer length of stay and $865 higher total hospitalization costs.”

In conclusion the authors write: “That patient preference for participation is associated with increased resource use contrasts with some perspectives on shared decision making that emphasize reductions of inappropriate use. However, in the presence of physician incentives to decrease use, such as exist for hospitalized patients and are likely to increase under health reform, increased resource use may occur. Future studies related to patient participation in decision making should examine effects on both outcomes and costs.”

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