Association of patient preferences for participation in decision making with length of stay and costs among hospitalized patients

Abstract

Importance: Patient participation in medical decision making has been associated with improved patient satisfaction and health outcomes. However, there is little evidence concerning its effects on resource utilization. Patient participation in medical decision making has been hypothesized to decrease excess utilization but might be expected to increase utilization when other decision makers have incentives to reduce utilization, as under prospective payment systems for hospital care.

Objective: To examine the relationship between patient preferences for participation in medical decision making and health care utilization among hospitalized patients.

Design and setting: Survey study in an academic research setting.

Participants: A survey that included questions about preferences to receive medical information and to participate in medical decision making was administered to all patients admitted to the University of Chicago Medical Center general internal medicine service between July 1, 2003, and August 31, 2011, and completed by 21,754 (69.6%) of admitted patients.

Main outcomes and measures: The survey data were linked with administrative data, including length of stay and total hospitalization costs. We used generalized linear models to measure the association of patient preference for participation in decision making with length of stay and costs.

Results: The mean length of stay was 5.34 days, and the mean hospitalization costs were $14,576. While 96.3% of patients expressed a desire to receive information about their illnesses and treatment options, 71.1% of patients preferred to leave medical decision making to their physician. Preference to participate in decision making increased with educational level and with private health insurance. Compared with patients who had a strong desire to delegate decisions to their physician, patients who preferred to participate in decision making concerning their care had a 0.26-day (95% CI, 0.06-0.47 day) longer length of stay (P = .01) and $865 (95% CI, $155-$1575) higher total hospitalization costs (P = .02).

Conclusions and relevance: Patient preference to participate in decision making concerning their care may be associated with increased resource utilization among hospitalized patients. Variation in patient preference to participate in medical decision making and its effects on costs and outcomes in the presence of varying physician incentives deserve further examination.

Figure 1

Length of stay (A) and total hospitalization costs (B) according to medical decision preferences. The mean length of stay and total hospitalization costs are adjusted predicted values without controlling for any covariates.

Figure 2

Medical decision preferences according to baseline characteristics by age, sex, race/ethnicity, educational level, health insurance type, and general self-assessed health status. By t test, P < .001 for all except P = .47 for general self-assessed health status.