Patient-centered care and outcomes after myocardial infarction

• Objective: To examine the relationship between patient-reported experience of hospital care for acute myocardial infarction (AMI) and subsequent outcomes. • Design: Prospective observational cohort study. • Setting/participants: 2272 AMI patients discharged from 23 New Hampshire hospitals during 1996 and 1997. • Measurements: Outcomes included cardiac rehospitalizations and/or cardiac mortality within the first year. We used patient responses to Picker survey items about their care to compute an overall problem score, classifying patients with top quartile scores as “worse care” and others as “better care. ” Propensity score matching was used to adjust for baseline differences in selected demographic and clinical characteristics between the 2 groups. • Results: Postdischarge surveys were completed by 1253 (55%) eligible patients. In unmatched analyses, better care patients had an equivalent annual rate of cardiac rehospitalization or cardiac death compared with worse care patients (–0.09 [95% confidence interval {CI}, –0.19 to 0.01]; P = 0.11). Propensity score matching did not reveal a difference in annual cardiac event rates between worse and better care patients (0.05 [95% CI, –0.09 to 0.2]; P = 0.48). • Conclusion: Patient-reported problems with AMI hospital care were not predictive of 1-year cardiac events among this cohort of New Hampshire patients. Larger cohort studies in other settings would help clarify whether associations differ in more diverse patient populations and detect any small, but clinically important, effects. Patient-centered care refers to health care processes that are highly responsive to patient needs and preferences [1]. It is a fundamental component of humane, highquality care [2,3] and is positively linked to patient satisfaction [4], treatment adherence, effective disease self-management, and low symptom burden [5,6]. In response to such findings as well as studies showing relatively low rates of adherence with patient-centered aspects of care, the Institute of Medicine [7] and the Department of Health and Human Services [8] have identified patient-centered care as a top priority for improving health care, and the use of surveys to measure patient experiences with hospitalization has proliferated. Despite increased focus on patient-centered care, the relationship between patient-centered aspects of care and subsequent clinical outcomes remains unclear, particularly among disease-specific cohorts, such as patients with acute myocardial infarction (AMI). One previous study showed that negative experiences with hospital care were associated with worse selfreported health status and self-reported chest pain in the year following the initial AMI hospitalization [9]. A second study showed a similar association between problems with care and self-reported health status 3 months postdischarge [10]. However, we are unaware of prior studies that have prospectively examined the link between measures of patient-centered care and more objective clinical events in AMI patients. In this report, we examine whether patients’ experiences with their AMI hospital care are associated with 1-year cardiac events, including cardiac rehospitalization and/or cardiac mortality. We hypothesized that better patient experience with hospital care would be associated with fewer 1-year cardiac events.