In the study, conducted by researchers with the University of Illinois at Chicago and the U.S. Veteran Affairs Department, 774 patients secretly made audio recordings of their visits to two Chicago VA facilities with 139 resident internists. The physicians had previously agreed to participate in the study, but were unaware of which patients were recording their encounters. The VA-funded study, conducted in fiscal 2012, continued until researchers obtained three recordings for each participating physician in which a “contextual red flag” was identified.
“If the patient has, for example, a chronic condition like diabetes or hypertension that's going out of control, we would say that that's also a contextual issue and probably a sign that something is going on in that patient's life that needs to be addressed,” the study's lead author, Dr. Saul Weiner, a UIC professor of medicine and a staff physician at the Jesse Brown VA Medical Center in Chicago, said in a news release. “What our study really tells us is that the information that patients divulge during appointments about their life situation is critical to address and take into account if we're looking for optimal healthcare outcomes.”
There were 208 contextual red flags identified in the recordings. Of these, 123 resulted in a contextual care plan. Outcome data was available for 157 of the red flag encounters, including 96 in which the contextual issues for nonadherence were addressed. Of these, healthcare outcomes improved in 68 (71%) of the cases compared with 28 (46%) in which contextual issues were not addressed. Positive outcomes included keeping appointments, filling prescriptions and refills, having recommended tests, procedures or vaccines done, and improved measures for diabetes and hypertension.
In an accompanying editorial, written by physicians with Johns Hopkins University School of Medicine in Baltimore, it was noted that the resident internists in the study did a better job of following up on nonadherence to treatment plans, but gave less attention to the context behind emergency department visits and missed appointments.
“As the focus on improving healthcare outcomes intensifies and healthcare organizations are increasingly being held accountable for them, it is becoming more important than ever to broaden efforts for improving healthcare quality and outcomes,” the authors wrote in the editorial. “Innovative interventions that go beyond individual patients and physicians within the walls of clinics and hospitals are needed.”
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