1034 — The Role of Communication among Primary Care Team Members and Patient-Provider Communication in Predicting Patients' Satisfaction with Their Providers

Lead/Presenter: Susan Stockdale, COIN - Los Angeles
All Authors: Stockdale SE (Center for the Study of Healthcare Innovation, Implementation, and Policy) Rose D (Center for the Study of Healthcare Innovation, Implementation, and Policy) Darling JE (Center for the Study of Healthcare Innovation, Implementation, and Policy) Meredith LS (RAND Corporation) Helfrich CD (Puget Sound VA) Dresselhaus TR (San Diego VA Healthcare System) Roos P (Loma Linda VA Healthcare System) Rubenstein LV (Center for the Study of Healthcare Innovation, Implementation, and Policy)

Objectives:
Successful patient-centered medical home model (PCMH) adoption could improve patient satisfaction with primary care provider (PCP) by fostering a clinic organizational environment that supports communication among team members and patient-provider communication, but patient satisfaction might suffer if patients perceive that team-based care impairs their communication with their PCPs. No studies have examined whether and how communication among team members within a PCMH clinical environment might shape patient-provider communication and patients' satisfaction with their PCPs. We examined the association between PCP-reported communication within the primary care practice and patient-reported satisfaction with their PCPs. We tested the extent to which patient-reported patient-provider communication explained this association.

Methods:
We matched cross-sectional self-administered surveys of a) VHA PCPs (n = 129) and b) patients of these providers (n = 3298) for one administrative region in 2011-12. We assessed the quality of PCP-reported communication within the primary care practice using items from the Organizational Readiness to Change Assessment, which measures the ability of teams in the clinic to handle conflict and work together. We assessed patient-provider communication and patient satisfaction with their provider using Consumer Assessment of Healthcare Provider and Systems measures from VHA's routinely administered Survey of Healthcare Experiences of Patients. We analyzed matched patient-provider pairs using hierarchical linear regression to account for nested data structure and controlled for PCP and patient characteristics. Analyses controlled for other clinic environment, PCP, and patient factors associated with patients' satisfaction with their PCP.

Results:
PCP-reported communication within the primary care practice and patient-reported patient-provider communication were independently and significantly associated with patient satisfaction with PCP. Patient-reported patient-provider communication explained 56% of the association between provider-reported communication within the primary care practice and patient satisfaction. Good communication within the primary care practice combined with good patient-provider communication predicted higher satisfaction levels (81%), as compared to poor within-practice communication combined with poor patient-provider communication (22%).

Implications:
A PCMH environment that supports good communication among primary care team members may facilitate patient-provider communication and result in higher patient satisfaction with PCP.

Impacts:
Clinic-level interventions to support good communication within the clinic may be necessary in addition to interventions targeting the patient-provider interaction.