Provider behaviors or consumer participation: How should we measure person-centered care?

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Samantha M. Hack
Anjana Muralidharan
Clayton H. Brown
Alicia A. Lucksted
Jennifer Patterson


Current research has found that higher rates of patient-centered care (PCC) are associated with greater treatment adherence and positive treatment outcomes. However, the instruments used to access PCC primarily collect data on provider behavior, rather than consumer participation in PCC, despite the necessary co-equal and collaborative nature of PCC interactions.Cross-sectional survey data was collected from 82 mental health care consumers receiving services at two Veterans Health Administration (VHA) facilities. Participants completed surveys on perceptions of PCC, consumer involvement in care, therapeutic alliance, medication adherence, and mental health care system mistrust.Pearson correlations examined associations between scales. Multiple regression analyses were used to test whether person-centeredness and consumer involvement in care are significant independent explanatory predictors of the identified outcome variables. Significant correlation between the consumer participation and PCC subscales was mixed. Higher levels of PCC were associated with greater therapeutic alliance, less suspicion of mental health care systems, less perception of lack of support from providers, and less beliefs about group disparities in care. Consumer involvement was only significantly related to suspicion of mental health care systems.Perceived PCC was a better explanatory variable than consumer involvement in care for most of the dependent variables. This may be a function of the locus of each outcome variable. When selecting PCC measures, researchers may wish to consider whether the variables of interest are related to the consumer-/provider-as-person or the consumer-provider relationship in order to inform instrument selection.

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Agency for Healthcare Research and Quality. (n.d.). Patient Centered Medical Home Resource Center. Available at (last accessed 7 December 2016)

Veterans Health Administration. (2014). Blueprint for Excellence. (last accessed 7 December 2016)

Institute of Medicine. (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C.: National Academy Press.

New Freedom Commission on Mental Health. (2003). Achieving the Promise: Transforming Mental Health Care in America. Final Report. Rockville, MD: DHHS Pub. No. SMA-03-3832.

Stewart, M., Brown, J.B., Weston, W.W., McWhinney, I.R., McWilliam, C.L., Freeman, T.R. (2014). Patient-Centered Medicine: Transforming the Clinical Method. London: Radcliffe Publishing.

Hudon, C., Fortin, M., Haggerty, J.L., Lambert, M., Poitras, M. (2011). Measuring Patients’ Perceptions of Patient-Centered Care: A Systematic Review of Tools for Family Medicine. Annals of Family Medicine 9: 155-164.

Little, P., Everitt, H. Williamson, I., Warner, G., Moore, M., Gould, C., Ferrier, K., Payne, S. (2001). Observational Study of Effects of Patient Centredness and Positive Approach on Outcomes of General Practice Consultations. BMJ 323: 908-911.

Epstein, R.M, Franks,P., Fiscella, K., Shields, C.G., Meldrum, S.C., Kravitz, R.L., Duberstein, P.R. (2005). Measuring Patient-Centered Communication in Patient-Physician Consultation: Theoretical and Practical Issues. Social Science & Medicine 61: 1516-1528.

Lerman, C.E., Brody, D.S., Caputo, G.C., Smith, D.G., Lazaro, C.G., Wolfson, H.G. (1990). Patient’s Perceived Involvement in Care Scale: Relationship to Attitudes about Illness and Medical Care. Journal of General Internal Medicine 5: 29-33.

Matthias, M.S., Salyers, M.P., Rollins, A.L., Frankel, R.M. (2012). Decision Making in Recovery-Oriented Mental Health Care. Psychiatric Rehabilitation Journal 35: 305-314.

Morgan, S., Yoder, L.H. (2012). A Concept Analysis of Person-Centered Care. Journal of Holistic Nursing 30: 6-15.

Moseson, E.M., Wiener, R.S., Golden, S.E., Au, D.H., Gorman, J.D., Laing, A.D., Deffebach, M.E., Slatore, C.G. (2016). Patient and Clinician Characteristics Associated with Adherence: A Cohort Study of Veterans with Incidental Pulmonary Nodules. Annals of American Thoracic Society 13: 651-659.

Huff, N.G., Nadig, N., Ford, D.W., Cox, C.E. (2015). Therapeutic Alliance between the Caregivers of Critical Illness Survivors and Intensive Care Unit Clinicians. Annals of the American Thoracic Society 12: 1646-1653.

Stewart, M., Brown, J.B., Donner, A., McWhinney, I.R., Oates, J., Weston, W.W., Jordan, J. (2000). The Impact of Patient-Centered Care on Outcomes. The Journal of Family Practice 49: 796-804.

Hansen, B.R., Hodgson, N.A., Gitlin, L.N. (2016). It’s a Matter of Trust: Older African American Speak About Their Health Care Encounters. Journal of Applied Gerontology 35: 1058-1076.

Upshur, C.C., Bacigalupe, G., Luckmann, R. (2010). “They Don’t Want Anything to Do with You”: Patient Views of Primary Care Management of Chronic Pain. Pain Medicine 11: 1791-1798.

Beach, M.C., Sugarman, J., Johnson, R.L., Arbelaez, J.J., Duggan, P.S., Cooper, L.A. (2005). Annals of Family Medicine 3: 331-338.

Janssen, C. Ommen, O., Neugebauer, E., Lefering, R., Pfaff, H. (2007). How to Improve Satisfaction with Hospital Stay of Severely Injured Patients. Langenbeck’s Archives of Surgery 392: 747-760.

Brekke, M., Hjortdahl, P., & Kvien, T.K. (2001) Involvement and Satisfaction: A Norwegian Study of Health Care Among 1,024 Patient with Rheumatoid Arthritis and 1,509 Patient with Chronic Noninflammatory Musculoskeletal Pain. Arthritis Care & Research 45: 8-15.

Farin, E., Meder, M. (2010). Personality and the Physician-Patient Relationship as Predictors of Quality of Life of Cardiac Patients After Rehabilitation. Health and Quality of Life Outcomes 8: 1-11.

Farin, E., Nagel, M. (2013). The Patient-Physician Relationship in Patients with Breast Cancer: Influence on Changes in Quality of Life After Rehabilitation. Quality of Life Research 22: 283-294.

Street, R.L., Gordon, H., Haidet, P. (2007). Physicians’ Communication and Perceptions of Patients: Is It How They Look, How They Talk, or Is It Just the Doctor? Social Science & Medicine 65: 586-598.

Horvath, A.O., Greenberg, L.S. (1989). Development and Validation of the Working Alliance Inventory. Journal of Counseling Psychology 36: 223-233.

Tichenor, V., Hill, C.E. (1989). A Comparison of Six Measures of Working Alliance. Psychotherapy: Theory, Research, Practice, Training 26: 195-199.

Morisky, D.E., Ang A., Krousel-Wood M., Ward H. (2008). Predictive Validity of a Medication Adherence Measure for Hypertension Control. Journal of Clinical Hypertension 10: 348-354.

Krousel-Wood, M.A., Islam, T., Webber, L.S., Re, R.S., Morisky, D.E., Muntner, P. (2009). New Medication Adherence Scale Versus Pharmacy Fill Rates in Seniors With Hypertension. American Journal of Managed Care 15: 59-66.

Reynolds, K., Viswanathan, H., O'Malley, C.D., et al. (2012). Psychometric Properties of the Osteoporosis-Specific Morisky Medication Adherence Scale (OS-MMAS) in Postmenopausal Women with Osteoporosis Newly Treated with Bisphosphonates. Annals of Pharmacotherapy 46: 659-670.

Thompson, H.S., Valdimarsdottir, H.B., Winkel, G., Jandorf, L., Redd, W. (2004). The Group-Based Medical Mistrust Scale: Psychometirc Properties and Association with Breast Cancer Screening. Preventive Medicine 38: 209-218.

Mead, N., Bower, P. (2000). Patient-centredness: A Conceptual Framework and Review of the Empirical Literature. Social Science & Medicine 51: 1087-1110.

Davidson, L., Tondora, J., Miller, R., O’Connell, M.J. (2015). Person-centered Care. In: Person-centered Care for Mental Illness: The Evolution of Adherence and Self-determination (ed. P.W. Corrigan), pp. 81-102. Washington, DC: American Psychological Association.