Is Shared Decision-Making Bad for the Bottom Line?


A new study shows that hospitalized patients who were more engaged in their own care produced higher costs and longer lengths of stay (LOS).

The report, "Association of Patient Preferences for Participation in Decision Making With Length of Stay and Costs Among Hospitalized Patients," published in JAMA Internal Medicine, used a survey of 21,754 patients in one academic setting to determine their preferences on shared decision-making. The information was later linked to administrative data.

Patients who said they preferred to participate in decision-making with their physicians had a 0.26-day (95% CI, 0.06-0.47 day) longer LOS (P=0.01) and incurred an average of $865 (95% CI, $155-$1,575) in higher total hospitalization costs (P=0.02). Patients with higher education levels and private health insurance were more likely than others to want to participate in decision-making with doctors, the authors noted.

Lead author Hyo Jung Tak, PhD, of the department of medicine at the University of Chicago says that while the results don't mean that patient-centered care directly drives up costs, it is important not to accept at face value that engaged patients lead to reduced health-care-delivery costs.

“These days,” she adds, “many researchers and policymakers expect that patient-centered care could help to reduce medical utilization as it could prevent costly interventions that patients may not want, but I think people should be more careful in terms of how it really applies in the clinical setting.”

Dr. Tak cautions that many variables could affect how a similar study would work at other hospitals, including an institution’s payor mix and the socioeconomic status of its service area. She said a potentially larger issue is why some patients strongly disagree with the idea of leaving medical decisions up to their physicians.

“If we can find that answer, that could help to improve patient-centered care in the future,” Dr. Tak adds. “That could be the ultimate question in this study.”

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