-- Mary Elizabeth Dallas
TUESDAY, May 28 (HealthDay News) -- Although doctors and
patients have long been urged to share decision-making, new
research finds that patients who are involved in their care spend
more time in the hospital and increase the cost of their hospital
Researchers at the University of Chicago Medical Center found
that patients who share in decision-making raise the cost of their
admission by an average of $865.
"The result that everyone would have liked -- that patients who are more engaged in their care do better and cost less -- is not what we found in this setting," the study's author, Dr. David Meltzer, associate professor of medicine, economics and public policy at the University of Chicago, said in a university news release. "Patients who want to be more involved do not have lower costs. Patients, as consumers, may value elements of care that the health care system might not."
The researchers said there are roughly 35 million
hospitalizations each year in the United States. They calculated
that if 30 percent of those patients shared in decision-making on
their care instead of allowing their doctor to call the shots, it
would result in $8.7 billion in additional costs every year.
Meltzer said he was not surprised by the findings. "I wasn't
shocked. It could have gone either way. Our results suggest that
encouraging patients to be more involved will not, alone, reduce
costs," he said. "We need to think harder and learn more about what
it means to empower patients in multiple health care settings and
how incentives facing both patients and caregivers in those
settings can influence decisions."
For the study, which was published in the May 27 issue of the
JAMA Internal Medicine, the researchers asked all patients
admitted to the University of Chicago's general internal medicine
service between July 2003 and August 2011 to complete an extensive
survey. Nearly 22,000 people participated.
The surveys revealed that 37.6 percent of the patients felt
strongly about wanting to leave the decision-making on their
medical care to their doctor. Another 33.5 percent agreed somewhat
and 28.9 percent disagreed with that approach.
The patients who preferred to work with their doctor rather than
delegate decisions spent roughly 5 percent more time in the
hospital and incurred about 6 percent higher costs, the study
The researchers also considered patients' insurance. They found
that provider incentives to use fewer services were not the only
predictors of care costs. Although uninsured patients had shorter
stays and lower hospitalization costs, those with public insurance
that pays less than the cost of care had longer than average
admissions and higher costs.
The study's authors also said 75 percent of the patients
involved in the study were black and more than half of the
participants had a high school education or less. They said 80
percent were covered by Medicare or Medicaid or were uninsured.
"This isn't about demographics," Meltzer said. The study showed that patients with the most education had lower costs than those with the least education.
"We want patients to be more involved, to have the richest form of interaction," Meltzer said. "That can align preferences, prevent mistakes and avoid treatments patients don't want. But we need to find ways to create functional doctor-patient partnerships that lead to good health as well as sound decisions about resource utilization."
The researchers also said, however, that their findings may not
apply in every hospital setting.
The American Medical Association provides more information on
patient-doctor relationship issues.
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