Patient-centeredness and its impact on patient satisfaction and treatment outcomes in medical rehabilitation
Introduction
Patient-centeredness has played an increasingly important role in health care in recent years. It is an essential principle of medical rehabilitation and is viewed as an important quality and outcome criterion [1], [2], [3]. Both the health service and policies call for patient-centered care to be implemented in practice [4]. Despite the relevance of patient-centeredness, no standardized definition for this construct has been given to date [3], [5], [6]. The Institute of Medicine [7] refers to patient-centered care as “providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions”. According to Robinson et al. [4] patient-centered care essentially ensures that patients assume responsibility for their health care whereby patients are included and treatment is individualized.
There are heterogeneous models of varying complexity focusing on dimensions of patient-centeredness [1], [3], [5], [9], [10], [11], [12], [13], [14], [15]. In order to establish convergent conceptualization, Scholl, Zill, Härter and Dirmaier [16] developed an integrated model of patient-centeredness with 15 dimensions, based on a systematic review of definitions and models. A conclusive expert survey confirmed the TOP 5 dimensions as follows: Patient as a unique person, patient involvement in care, patient information, clinician-patient communication and patient empowerment [8].
There has been little evidence of the effectiveness of patient-centered treatment in the rehabilitation setting to date [8]. Results regarding efficacy and outcomes in the acute care setting are inconsistent [17]. Frequently, only individual components of patient-centered care or related constructs have been investigated, not the overall concept. For example, the impact of shared decision-making has been examined in several studies with findings including greater patient satisfaction, better quality of life and improved patient compliance [10], [18], [19]. A systematic review of patient-centered care and its impact reported positive correlations with patient satisfaction and self-management in particular, with less positive impact on health status [20]. In patients with chronic disease, Michie et al. [13] found correlations between patient-centeredness and patient satisfaction, treatment compliance, and physical health. Dirmaier et al. [8] highlighted similar findings with a mostly positive impact on patient satisfaction and, in individual cases, also on health-related outcomes. However, many of the studies conducted thus far have been in primary care [18].
The unique characteristics of the medical rehabilitation setting in Germany include treatment of the chronically ill patient by an interdisciplinary rehabilitation team (physicians, nurses, physiotherapists, occupational therapists, psychologists, social workers) in an inpatient rehabilitation center for three weeks. A core assignment of rehabilitation is the improvement or recovery of functioning and functional health, as it is defined by the ICF [23], in levels of performance and participation. Therefore, participation in professional and daily life as well as health status are crucial in evaluating rehabilitation treatment. At the end of the rehab measure, medical rehabilitation should improve the patients' state of health [8]. For the evaluation of a received rehabilitation treatment, the assessment of patient satisfaction is standard [13], [20].
The aim of this study is to investigate the significance of patient-centeredness on patient satisfaction and treatment outcomes in medical rehabilitation. The following hypotheses were posed, based on the theoretical context and past research results: Hypothesis 1 Patient-centeredness has a positive impact on patient satisfaction. Hypothesis 2 Patient-centeredness has a positive impact on treatment outcomes:
(2a) regarding changes in living conditions;
(2b) regarding changes in state of health.
Section snippets
Design, setting and participants
The study was multicenter and cross-sectional with a questionnaire-based evaluation. Patients from nine rehabilitation clinics in southwest Germany (Orthopedics, Neurology, Oncology and Cardiology) participated in the study at the end of their stay in the rehabilitation center. The inclusion criteria were as follows: (1). Participation in an inpatient rehabilitation treatment at one of the participating treatment centers, (2). over the age of 18, (3). Adequate knowledge of the German language,
Results
Out of the 1618 questionnaires distributed, 1106 were completed, which equates to a response rate of 68% (variation ranging from 29 to 99% between clinics, n = 21–99, n counted per phase and clinic). After excluding all surveys (n = 39) from one clinic, in which participation during Phase 1 was inadequate (response rate < 30%), and following the missing data analysis [28], a data set of n = 1033 remained. In this data set the input of missing values were completed.
Average age was 61.2 years, the
Discussion of results
Patient-centeredness has proved to be a significant predictor for patient satisfaction and treatment outcomes reflected in changes in living conditions and state of health and well-being. All three patient-centeredness dimensions (CCRQ-15 scales) and the disease-related factor (neurological indication) were significant predictors of patient satisfaction. Self-management/patient empowerment in particular was to be the most significant predictor for treatment outcomes. Decision-making and
Conflict of interest
The authors declare that there are no conflicts of interest.
Funding and acknowledgement
The study “Development and evaluation of a concept on patient-centered team training in rehabilitation clinics − PATENT” was funded by the German Federal Ministry of Education and Research and the German Statutory Pension Insurance under the “chronic diseases and patient focus” funding priority (study no.: FKZ 01GX1024). We also note our sincere appreciation to the participating rehabilitation centers and the study participants.
References (42)
- et al.
Patient-centredness: a conceptual framework and review of the empirical literature
Soc. Sci. Med.
(2000) - et al.
Patient-centredness in chronic illness: what is it and does it matter?
Patient Educ. Couns.
(2003) - et al.
Emotional exhaustion and workarounds in acute care: cross sectional tests of a theoretical framework
Int. J. Nurs. Stud.
(2012) - et al.
Patient satisfaction revisited: a multilevel approach
Soc. Sci. Med.
(2009) - et al.
The relation between patient-centeredness and patient empowerment: a discussion on concepts
Patient Educ. Couns.
(2010) - et al.
Predictors of patient satisfaction
Soc. Sci. Med.
(2001) Patientenorientierung als Qualitätsmerkmal [Patient-centeredness as a quality characteristic]
(2005)- et al.
Die Bedeutung von Organisationsmerkmalen für den Rehabilitationserfolg [The relevance of organizational features for rehabilitation treatment success]
Rehabilitation (Stuttg.)
(2011) Patient-centered care through internal and external participation in medical rehabilitation
Health (N. Y.)
(2013)- et al.
Patient-centered care and adherence: definitions and applications to improve outcomes
J. Am. Acad. Nurse Pract.
(2008)
Reliability and construct validity of the client-centred rehabilitation questionnaire
Disabil. Rehabil.
Patientenzufriedenheit: Konzepte, Methoden und Problembereiche [patient satisfaction: concepts, methods and areas of concern]
Crossing the Quality Chasm: A New Health System for the 21st Century
Patient-centered communication and diagnostic testing
Ann. Fam. Med.
Ein Modell der partizipativen Entscheidungsfindung in der medizinischen Rehabilitation [A model of shared decision-making in medical rehabilitation]
Rehabilitation (Stuttg.)
Person-centredness: conceptual and historical perspectives
Disabil. Rehabil.
Patient-Centered Medicine: Transforming the Clinical Method
Evaluation of dimensions and measurement scales in patient-centeredness
J. Patient Preference Adherence
An integrative model of patient-centeredness—a systematic review and concept analysis
PLoS One
Behaviorally defined patient-centered communication—a narrative review of the literature
J. Gen. Intern. Med.
Cited by (37)
Factors Influencing Patient Experience After Cubital Tunnel Syndrome Surgery
2023, Journal of Hand SurgeryEntrepreneurship and subjective vs objective institutional performance: A decade of US hospital data
2022, Research PolicyCitation Excerpt :Although innovations designed for other (e.g., military) purposes can be productively translated into life-saving technologies hospitals use on a daily basis to improve their objective performance (Nelson et al., 2011), hospitals are not capitalizing on entrepreneurial activity in their surroundings to the same extent to improve their subjective performance. Indeed, such divergence is striking, especially because subjective performance in the form of patient satisfaction is directly related to improved medical outcomes (Plewnia et al., 2016). In other words, if hospitals were to learn from local entrepreneurial activity how to improve their service experience, their patient medical outcomes could further improve.