Patient surveys that ask about patient-centered processes of care are increasingly used for quality improvement and accreditation purposes. However, much is to be learned about whether and how such patient-reported problems may lead to worse clinical outcomes, particularly among disease-specific cohorts such as acute myocardial infarction (AMI) patients. In a time of growing demands to improve quality with increasingly limited resources, such information is crucial to helping providers and policy makers evaluate the best ways to enhance care and outcomes. Research on the quality of AMI care typically focuses on technical aspects of care, such as the use of specific medications and procedures. Non-technical aspects of care that are highly salient to patients and their families, such as education about their condition, emotional support, and discharge planning, are rarely considered. Consequently, little is known about the extent to which patient-centered processes of care affect recovery from an AMI and longer-term health outcomes. In previous research, investigators found that AMI patients reporting worse patient-centered care during hospitalization had worse self-reported health status and were more likely than other patients to report chest pain 1 year after their AMI. However, the association between a negative hospital experience and subsequent outcomes appeared to be offset by a positive experience with follow-up outpatient care. We propose to extend and clarify the results from that study by obtaining additional data and employing a variety of new analytic methods that will allow fuller assessment of the effects of various aspects of patient-centered care during the first post-MI year on several new and more objective outcomes.
Specific aims are (1) examine whether AMI patients' experiences with patient-centered aspects of care predict subsequent cardiac events, utilization, and mortality, and (2) to assess the relative effects of different aspects of patient-centered care and explore possible pathways by which patient-centered care (PCC) may affect long-term outcomes.
