Chartbook on Person- and Family-Centered Care

Person-Centered Care Measures That Achieved Success, Improved Quickly, or Showed Worsening Quality

• Two Person-Centered Care measures achieved 95% performance and will no longer be reported in the QDR.
  • People with a usual source of care for whom health care providers explained and provided all treatment options.
  • Hospice patients who received the right amount of medicine for pain management.
• No Person-Centered Care measures:
  • Improved quickly, defined as an average annual rate of change greater than 10% per year.
  • Showed worsening quality.

Disparities in Person-Centered Care Measures

Number and percentage of person-centered care measures for which members of selected groups experienced better, same, or worse quality of care compared with reference group

Key: n = number of measures; AI/AN = American Indian or Alaska Native.
Note: Poor indicates family income less than the Federal poverty level; High Income indicates family income four times the Federal poverty level or greater. Numbers of measures differ across groups because of sample size limitations. For most measures, data from 2012 are shown.
The relative difference between a selected group and its reference group is used to assess disparities.

• Better = Population received better quality of care than reference group. Differences are statistically significant, are equal to or larger than 10%, and favor the selected group.
• Same = Population and reference group received about the same quality of care. Differences are not statistically significant or are smaller than 10%.
• Worse = Population received worse quality of care than reference group. Differences are statistically significant, are equal to or larger than 10%, and favor the reference group.

• For 85% of person-centered care measures, people in poor households received worse care than people in high-income households
• Racial and ethnic disparities in person-centered care were also common.

Person-Centered Care Measures With Elimination or Widening of Disparities

• Two Person-Centered Care measures showed elimination of Asian-White disparities:
  • Adult hospital patients who sometimes or never had good communication with doctors.
  • Adults who had a visit in the last 12 months whose health providers sometimes or never listened carefully to them.
• Four Person-Centered Care measures showed widening of disparities for some groups:
  • Family caregivers who did not want more information about what to expect while the patient was dying.
  • Hospice patient caregivers who perceived patient was referred to hospice at right time.
  • Hospice patients who received care consistent with their stated end-of-life wishes.
  • Hospice patients who received the right amount of medicine for pain management.

Measures of Person- and Family-Centered Care

• The National Healthcare Quality and Disparities Report tracks a growing number of person- and family-centered care measures.
• The measures focus on three aspects of care:
  • Communication: doctor's office, hospital, and home health care.
  • Engagement in decisionmaking.
  • End-of-life care.

Communication

• Optimal health care requires good communication between patients and providers, yet barriers to provider-patient communication are common.
• To provide all patients with the best possible care, providers need to understand patients' diverse health care needs and preferences and communicate clearly with patients about their care.

Communication Measures: Doctor's Office

• Adults who had a doctor's office or clinic visit in the last 12 months who reported poor communication with health providers, by insurance, ages 18-64 and age 65 and over, 2002-2012.
• Adults who had a doctor's office or clinic visit in the last 12 months who reported poor communication with health providers, by ethnicity and education, 2002-2012.
• Children who had a doctor's office or clinic visit in the last 12 months whose parents reported poor communication with health providers, by ethnicity and language spoken at home, 2002-2012.

Poor Communication With Health Providers: Adults

Adults who had a doctor's office or clinic visit in the last 12 months who reported poor communication with health providers, by insurance, ages 18-64 and age 65 and over, 2002-2012

• From 2002 to 2012, the percentage of adults who reported poor communication with health providers significantly decreased among all groups except Medicare and other public insurance. There were no statistically significant changes for this group.
  • Adults ages 18-64:
    • Private insurance: 10.4% to 6.7%.
    • Public insurance: 15.6% to 14.6%.
    • Uninsured adults: 18.8% to 15.3%.
  • Adults age 65 and over:
    • Medicare and private insurance: 6.6% to 5.6%.
    • Medicare and other public insurance: 8.6% to 6.4%.
    • Medicare only: 8.7% to 5.2%.
• In 2012, adults ages 18-64 with public insurance and uninsured adults were significantly more likely to report poor communication compared with adults with private insurance.
• There were no statistically significant differences by insurance among adults age 65 and over.

Adults who had a doctor's office or clinic visit in the last 12 months who reported poor communication with health providers, by ethnicity and education, 2002-2012

• From 2002 to 2012, the percentage of adults who reported poor communication with health providers significantly decreased for Whites, Hispanics, and all education groups. There were no statistically significant changes among Blacks.
  • Ethnicity:
    • Whites: 9.8% to 6.9%.
    • Hispanics: 15.6% to 10.9%.
  • Education:
    • Less than high school: 13.4% to 11.5%.
    • High school grad: 10.9% to 8.9%.
    • Any college: 9.7% to 6.7%.
• In 2012, Hispanics and Blacks were significantly more likely than Whites to have poor communication with their health providers.
• Also in 2012, adults with less than a high school education and high school graduates were significantly more likely to have poor communication with their health providers than those with any college education.

Poor Communication With Health Providers: Children

Children who had a doctor's office or clinic visit in the last 12 months whose parents reported poor communication with health providers, by ethnicity and language spoken at home, 2002-2012

• From 2002 to 2012, the percentage of children whose parents reported poor communication with health providers significantly decreased for all ethnic groups and both language groups.
  • Ethnicity:
    • Whites: 5.6% to 3.3%.
    • Blacks: 7.1% to 4.1%.
    • Hispanics: 10.2% to 4.8%.
  • Preferred language:
    • English: 6.3% to 3.5%.
    • Other: 11.7% to 4.7%.
• In 2012, parents of Hispanic children were significantly more likely to report poor communication compared with White adults. There were no statistically significant differences between Blacks and Whites or by preferred language.

Communication Measures: Hospital

• Adult hospital patients who reported poor communication with nurses and doctors, by age, 2009-2013.
• Adult hospital patients who did not receive good communication about discharge information, by race, 2009-2013.

Poor Communication With Doctors and Nurses in the Hospital

Adult hospital patients who reported poor communication with doctors and nurses, by age, 2009-2013

• From 2009 to 2013, the percentage of patients reporting poor communication significantly decreased among all age groups.
  • Communication with doctors:
    • 18-44 years: 5.0% to 4.6%.
    • 45-64 years: 5.7% to 5.4%.
    • 65 and over: 5.1% to 4.6%.
  • Communication with nurses:
    • 18-44 years: 6.2% to 5.0%.
    • 45-64 years: 6.4% to 5.2%.
    • 65 and over: 5.4% to 4.2%.
• In 2013, hospital patients ages 45-64 years were significantly more likely to report poor communication with doctors compared with patients ages 18-44 years. There was no statistically significant difference between patients age 65 and over and those ages 18-44.
• In 2013, hospital patients age 65 and over were significantly less likely to report poor communication with nurses compared with patients ages 18-44 years. There was no statistically significant difference between patients ages 45-64 years and those ages 18-44.

Poor Communication About Discharge Information

Adult hospital patients who did not received good communication about discharge information, by race, 2009-2013

• From 2009 to 2013, the percentage of patients who did not receive good communication about discharge information significantly decreased for all racial groups:
  • White: 15.5% to 11.5%.
  • Black: 18.2% to 13.0%.
  • Asian: 17.0% to 13.1%.
  • Native Hawaiian or Other Pacific Islander (NHOPI): 17.2% to 12.3%.
  • American Indian or Alaska Native (AI/AN): 17.4% to 12.7%.
• In 2013, Blacks, Asians, and AI/ANs were significantly less likely than Whites to receive good communication about discharge information. There were no statistically significant differences between Whites and NHOPIs.

Communication Measures: Home Health Care

• Provider-patient communication among adults receiving home health care, by language spoken at home, 2013.
• Provider-patient communication among adults receiving home health care, by race/ethnicity, 2013.

Provider-Patient Communication Among Home Health Care Patients

Provider-patient communication among adults receiving home health care, by language spoken at home, 2013

• In 2013, compared with English speakers, adults speaking Spanish or another language at home were significantly less likely to:
  • Always be informed about when their provider would arrive.
  • Always have things explained in a way that was easy to understand.
  • Always be treated as gently as possible.
  • Always be treated with courtesy and respect.
• Adults speaking a language other than English or Spanish were significantly less likely to always have the provider listen carefully to them compared with English- and Spanish-speaking adults.
• Adults speaking Spanish at home were significantly more likely to report that the provider always listened carefully to them compared with English-speaking adults.

Provider-patient communication among adults receiving home health care, by race/ethnicity, 2013

• In 2013, among home health care patients, compared with Whites:
  • Asians, AI/ANs, and Hispanics were significantly less likely to always be informed about when their provider would arrive.
  • Asians, NHOPIs, AI/ANs, and Hispanics were significantly less likely to always have things explained in a way that was easy to understand.
  • Asians, NHOPIs, and AI/ANs were significantly less likely to always be listened to carefully.
  • Blacks, Asians, NHOPIs, AI/ANs, and Hispanics were significantly less likely to always be treated as gently as possible.
  • Blacks, Asians, NHOPIs, AI/ANs, and Hispanics were significantly less likely to always be treated with courtesy and respect.

Engagement in Decisionmaking

• The increasing prevalence of chronic diseases has placed more responsibility on patients, since conditions such as diabetes and hypertension require self-management.
• Patients need to be provided with information that allows them to make educated decisions and feel engaged in their treatment.
• Treatment plans also need to incorporate patients' values and preferences.

Engagement in Decisionmaking Measures: Providers Asking Patients To Assist in Making Treatment Decisions

• Adults with a usual source of care whose health providers sometimes or never asked for the patient's help to make treatment decisions, by insurance and education, 2002-2012.
• People with a usual source of care whose health providers sometimes or never asked for the patient's help to make treatment decisions, by number of chronic conditions and ethnicity, 2002-2012.

Providers Who Sometimes or Never Asked for Patient's Help in Making Treatment Decisions

Adults with a usual source of care whose health providers sometimes or never asked for the patient's help to make treatment decisions, by insurance (ages 18-64) and education, 2002-2012

• In 2012, among adults ages 18-64, those who were uninsured those with public insurance were significantly less likely than those with private insurance to be asked by their health providers to help make treatment decisions.
• Also in 2012, adults with less than a high school education and high school graduates were significantly less likely than those with any college education to be asked to help make treatment decisions.

• Significant improvements were observed from 2002 to 2012:

  • Insurance:
    • Any private: 20.6% to 11.5%.
    • Public: 27.2% to 15.9%.
    • Uninsured: 25.2% to 15.2%.
  • Education:
    • Less than high school: 25.9% to 15.4%.
    • High school graduate: 22.6% to 14.2%.
    • Any college: 19.4% to 11.6%.

People with a usual source of care whose health providers sometimes or never asked for the patient's help to make treatment decisions, by number of chronic conditions and ethnicity, 2002-2012

• In 2012, among people with a usual source of care, patients with 4 or more chronic conditions were significantly less likely than those with 0 or 1 condition to be involved in their treatment decisions.
• Also in 2012, Blacks and Hispanics were significantly less likely than Whites to be involved in their treatment decisions.
• Significant improvements were observed from 2002 to 2012:
  • By number of chronic conditions:
    • 0-1 chronic conditions: 21.9% to 12.2%.
    • 2-3 chronic conditions: 20.7% to 13.6%.
    • 4+ chronic conditions: 26.7% to 15.4%.
  • By ethnicity:
    • Whites: 19.9% to 11.5%.
    • Blacks: 26.4% to 16.4%.
    • Hispanics: 27.6% to 14.5%.