Chartbook on Person- and Family-Centered Care

• Optimal health care requires good communication between patients and providers, yet barriers to provider-patient communication are common.
• To provide all patients with the best possible care, providers need to understand patients’ diverse health care needs and preferences and communicate clearly with patients about their care.
• The National Healthcare Quality and Disparities Report tracks a growing number of person- and family-centered care measures, focusing on three aspects of care:
  • Communication: doctor’s office, hospital, and home health care.
  • Engagement in decisionmaking.
  • End-of-life care.

Communication Measures: Doctor’s Office

Adults: Poor Communication With Health Providers, by Insurance

Adults who had a doctor’s office or clinic visit in the last 12 months who had poor communication with health providers, by insurance, ages 18-64 and age 65 and over, 2002-2013

Left Chart (Ages 18-64):

Right Chart (Age 65+):

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2002-2013.
Denominator: Civilian noninstitutionalized population age 18 and over who had a doctor’s office or clinic visit in the last 12 months.
Note: For this measure, lower rates are better. Adults whose health providers sometimes or never listened carefully, explained things clearly, respected what they had to say, or spent enough time with them are considered to have poor communication with health providers.

• Overall Rate: The percentage of adults who had a doctor’s office or clinic visit in the last 12 months who had poor communication with health care providers decreased over time.
• Trends: From 2002 to 2013, the percentage of adults who had poor communication with health providers significantly decreased among all groups except Medicare and other public insurance.
  • Adults ages 18-64:
    • Private insurance: 10.4% to 6.7%.
    • Public insurance: 15.6% to 13.8%.
    • No insurance: 18.8% to 14.4%.
  • Adults age 65 and over:
    • Medicare and private insurance: 6.6% to 4.0%.
    • Medicare only: 8.7% to 5.2%.
• Groups With Disparities:
  • In all years from 2002 to 2013, adults ages 18-64 who had public insurance or were uninsured were more likely than those with private insurance to have poor communication with their health providers.
  • Between 2002 and 2013, among adults ages 18-64, the gap grew between those with public insurance and those with private insurance, indicating worsening disparities.
  • In 9 of 12 years, adults age 65 and over with Medicare and other public insurance were more likely than those with private insurance to have poor communication with their health providers.

Adults: Poor Communication With Health Providers, by Ethnicity and Education

Adults who had a doctor’s office or clinic visit in the last 12 months who had poor communication with health providers, by ethnicity and education, 2002-2013

Left Chart:

Right Chart:

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2002-2013.
Denominator: Civilian noninstitutionalized population age 18 and over who had a doctor’s office or clinic visit in the last 12 months.
Note: For this measure, lower rates are better. White and Black are non-Hispanic. Hispanic includes all races. Less than high school refers to fewer than 12 years of education; high school graduate, 12 years of education; and any college, more than 12 years of education. Adults whose health providers sometimes or never listened carefully, explained things clearly, respected what they had to say, or spent enough time with them are considered to have poor communication with health providers.

• Trends: From 2002 to 2013, the percentage of adults who had poor communication with health providers significantly decreased for all ethnic groups and all education groups.
  • Ethnicity:
    • Whites: 9.8% to 6.7%.
    • Blacks: 11.5% to 9.2%.
    • Hispanics: 15.6% to 10.0%.
  • Education:
    • Less than high school: 13.4% to 10.9%.
    • High school graduate: 10.9% to 8.2%.
    • Any college: 9.7% to 6.8%.
• Groups With Disparities:
  • In all years from 2002 to 2013, Hispanics and Blacks were significantly more likely than Whites to have poor communication with their health providers.
  • In 10 of 12 years, high school graduates were more likely than those with any college to have poor communications with their health providers.
  • In 2013, adults with less than a high school education and high school graduates were significantly more likely to have poor communication with their health providers than those with any college education.
  • The gap is widening between adults with any college education and those with less than a high school education and high school graduates, indicating worsening disparities.

Children: Poor Communication With Health Providers

Children who had a doctor’s office or clinic visit in the last 12 months who had poor communication with health providers, by ethnicity and health insurance, 2002-2013

Left Chart:

Right Chart:

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2002-2013.
Note: For this measure, lower rates are better. White and Black are non-Hispanic. Hispanic includes all races. Children whose health providers sometimes or never listened carefully, explained things clearly, respected what they had to say, or spent enough time with them are considered to have poor communication with health providers.

• Trends: From 2002 to 2013, the percentage of children whose parents reported poor communication with health providers significantly decreased for all ethnic groups and health insurance groups.
  • Ethnicity:
    • Whites: 5.6% to 2.7%.
    • Blacks: 7.1% to 4.4%.
    • Hispanics: 10.2% to 4.9%.
  • Health insurance status:
    • Private: 5.3% to 2.1%.
    • Public: 10.6% to 5.6%.
    • Uninsured: 7.3% to 3.9%.
• Groups With Disparities:
  • In all years from 2002 to 2013, Hispanic children were significantly more likely than White children to have poor communications with their health providers.
  • In 2013, Hispanic children and Black children were significantly more likely than White children to report poor communication with their health care providers.
  • In all years, parents of children with public insurance were more likely than parents of children with private insurance to report poor communication.

Difficulty Understanding the Doctor Due to Language

Adults age 18 and over in California who experienced a communication barrier during their last doctor visit and reported language was the reason, by income, insurance status (>65 years old), and U.S. born, 2013-2014 combined

Source: University of California, Los Angeles, Center for Health Policy Research, California Health Interview Survey, 2013-2014 combined.
Note: For this measure, lower rates are better. This measure samples California civilian noninstitutionalized adults age 18 and over who experienced communication barrier during their last doctor visit.

• Groups With Disparities:
  • Among all adults who reported difficulty understanding their doctor during their last visit, the percentage who reported language was the reason was higher for individuals who were not born in the United States compared with those who were born in the United States.
  • There were no statistically significant differences by income or insurance.