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The Clinician-Patient Partnership Paradigm: Outcomes Associated With Physician Communication Behavior

Center for Managing Chronic Disease University of Michigan, Ann Arbor, Michigan, nmclark{at}umich.edu

Michael D. Cabana, MD, MPH

Department of Pediatrics University of California, San Francisco, California

Bin Nan, PhD

Department of Biostatistics, School of Public Health University of Michigan, Ann Arbor, Michigan

Z. Molly Gong, MD

Center for Managing Chronic Disease University of Michigan, Ann Arbor, Michigan

Kathryn K. Slish, MA

Department of Biostatistics, School of Public Health University of Michigan, Ann Arbor, Michigan

Nancy A. Birk, MA

Center for the Study of Higher and Postsecondary Education, School of Education University of Michigan, Ann Arbor, Michigan

Niko Kaciroti, PhD

Center for Managing Chronic Disease University of Michigan, Ann Arbor, Michigan

Objective: To identify physician communication behaviors associated with perceptions of quality of care and predictive of positive patient outcomes.

Patients and Methods: A total of 452 families seeing 48 pediatricians for a child's asthma participated. Perceptions and health care use were assessed at baseline and after 12 months through interviews and medical records. The measures used were 10 physician communication behaviors and 6 items describing physician's performance, asthma office visits, emergency department visits, and hospitalization.

Results: Positive perceptions of physicians' performance were related to (P .05) careful listening, inquiring about at-home management, nonverbal attention, interactive conversation, tailoring short-term goals, and long-term therapeutic plan. Loss in health care use was predicted (P .05) by interactive conversation, short-term goals, criteria for decision making, long-term treatment plan, and tailoring according to needs. The use of these techniques did not lengthen the patient visit. A clinician-patient partnership paradigm is provided based on these findings.

Conclusions: The specific clinician communication behaviors predicted reduced health care use and positive perceptions of quality of care.

Key Words: physician communication • outcomes • asthma • physician education

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