***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND There is general support for general practitioners ( GPs ) using patient-centred styles . However , there is limited British evidence of beneficial outcomes for patients from such styles . AIM To explore whether , for patients presenting for new episodes of care , the GP 's consulting style , specifically the patient-centredness of the consultation , is related to five generic outcomes . METHOD General practitioners in South Wales were recruited , and one surgery consulting session was audiotape recorded for each participating clinician . Question naires were given to consenting patients before their consultations , immediately afterwards , and , by post , at two weeks to measure the following outcomes : doctor-patient agreement ( on the nature of the problem and management ) , patient satisfaction , resolution of symptoms , resolution of concerns , and functional health status . From the patients consulting for a new episode of care and completing all three question naires , one patient was selected at r and om for each GP and the audiotape of their consultation rated for patient-centredness . Statistical analysis employed correlation coefficients and t-tests , followed by multiple regression and logistic regression to control for potential confounders . RESULTS In total , 143 patients consulting 143 GPs were studied . The patient-centred score was positively and statistically significantly associated with patient satisfaction ( Pearson correlation = 0.28 ; P = 0.002 ) . No other associations were found with the other outcomes measured . CONCLUSION The study presents evidence that patient-centred styles of consulting produce benefits in terms of increased patient satisfaction for patients consulting for new episodes of care in Britain PURPOSE : Little is known about how well hospitalized patients can identify errors or injuries in their care . Accordingly , the purpose of this study was to elicit incident reports from hospital in patients in order to identify and characterize adverse events and near-miss errors . SUBJECTS : We conducted a prospect i ve cohort study of 228 adult in patients on a medicine unit of a Boston teaching hospital . METHODS : Investigators review ed medical records  and interviewed  patients during the hospitalization and by telephone 10 days after discharge about “ problems , ” “ mistakes , ” and “ injuries ” that occurred . Physician investigators classified patients ’ reports . We calculated event rates and used multivariable Poisson regression models to examine the factors associated with patient-reported events . RESULTS : Of 264 eligible patients , 228 ( 86 % ) agreed to participate and completed 528 interviews . Seventeen patients ( 8 % ) experienced 20 adverse events ; 1 was serious . Eight patients ( 4 % ) experienced 13 near misses ; 5 were serious or life threatening . Eleven ( 55 % ) of 20 adverse events and 4 ( 31 % ) of 13 near misses were documented in the medical record , but none were found in the hospital incident reporting system . Patients with 3 or more drug allergies were more likely to report errors compared with patients without drug allergies ( incidence rate ratio 4.7 , 95 % CI 1.7 , 13.4 ) . CONCLUSIONS : In patients can identify adverse events affecting their care . Many patient-identified events are not captured by the hospital incident reporting system or recorded in the medical record . Engaging hospitalized patients as partners in identifying medical errors and injuries is a potentially promising approach for enhancing patient safety BACKGROUND Recent studies have suggested that there is a positive impact of patient-centered care ( PCC ) on both the patient-physician relationship and subsequent patient health-related behaviors . One recent prospect i ve study reported a significant relationship between the degree of PCC experienced by patients during their hospitalization for acute myocardial infa rct ion ( AMI ) and their postdischarge cardiac symptoms . A limitation of this study , however , was a lack of information regarding the technical quality of the AMI care , which might have explained at least part of the differences in outcomes . The present study was undertaken to test the influence of both PCC and technical care quality on outcomes among AMI patients . METHODS We analyzed data from a national sample of 1,858 veterans hospitalized for an initial AMI in a Department of Veterans Affairs medical center during fiscal years 2003 and 2004 for whom data had been compiled on evidence -based treatment and who had also completed a Picker question naire assessing perceptions of PCC .  Cox proportional hazards models were used to estimate the relationship between  PCC  and survival 1-year postdischarge , controlling for technical quality of care , patient clinical condition and history , admission process characteristics , and patient sociodemographic characteristics . We hypothesized that better PCC would be associated with a lower probability of death 1-year postdischarge , even after controlling for patient characteristics and the technical quality of care . RESULTS Better PCC was associated with a significantly but modestly lower hazard of death over the 1-year study period ( hazard ratio 0.992 , 95 percent confidence interval 0.986 - 0.999 ) . CONCLUSIONS Providing PCC may result in important clinical benefits , in addition to meeting patient needs and expectations OBJECTIVES To determine if a whole systems approach to self-management improves clinical outcomes and leads to cost-effective use of NHS services . DESIGN Nineteen hospitals were r and omised to 10 control sites and nine intervention sites . Consultants from intervention sites received training in patient-centred care before recruitment and introduced the intervention to eligible patients . Patients at the control sites were recruited and went on to have an ordinary consultation . Qualitative interviews were undertaken to obtain an in-depth underst and ing of patients ' and consultants ' experience of the intervention . SETTING Follow-up outpatient clinics at 19 hospitals in the north-west of Engl and . PARTICIPANTS Seven hundred patients ( 297 at intervention sites and 403 at control sites ) with established ulcerative colitis or Crohn 's disease , aged 16 years and over , and able to write in English .  INTERVENTIONS Consultants were trained to provide a patient-centred approach to care . Guidebooks on ulcerative colitis and Crohn 's disease were developed with patients prior to the study . Patients prepared a written self-management plan and self-referred to services based on a self-evaluation of their need for advice . MAIN OUTCOME MEASURES Rates of hospital outpatient consultation , quality of life ( QoL ) and acceptability to patients . Health service re source use and assessed cost effectiveness using the EQ-5D . RESULTS After 1 year , the intervention result ed in fewer hospital visits , without change in the number of primary care visits . Patients felt more able to cope with their condition . The intervention produced no reduction in QoL and did not raise anxiety . The intervention group reported fewer symptom relapses ; 74 % of patients in the intervention group indicated a preference to continue the system . Qualitative results showed the guidebook was effective but organisational limitations constrained patient-centred aspects of the intervention for some . Cost-effectiveness analyses favoured self-management over st and ard care . CONCLUSIONS Further use of this method in chronic disease management seems likely to improve overall patient satisfaction and reduce health expenditure without evidence of adverse effect on disease control . Further attention needs to be given to self-referral and access arrangements and a re-distribution of control to patients through increased adherence to patient-centred norms on the part of consultants . Future research is recommended to evaluate the operating systems within secondary and primary care that would allow self-managers to self-refer and to keep them informed of new treatments , also to explore models for training health professionals in self-care methods , to study long-term effects of self-management in chronic disease and to transfer this approach to other chronic conditions OBJECTIVE To ascertain whether the quality of physician-patient communication makes a significant difference to patient health outcomes . DATA SOURCES The MEDLINE data base was search ed for articles published from 1983 to 1993 using " physician-patient relations " as the primary medical subject heading . Several bibliographies and conference proceedings were also review ed . STUDY SELECTION R and omized controlled trials ( RCTs ) and analytic studies of physician-patient communication in which patient health was an outcome variable . DATA EXTRACTION The following information was recorded about each study : sample size , patient characteristics , clinical setting , elements of communication assessed , patient outcomes measured , and direction and significance of any association found between aspects of communication and patient outcomes . DATA SYNTHESIS Of the 21 studies that met the final criteria for review , 16 reported positive results , 4 reported negative ( i.e. , nonsignificant ) results , and 1 was inconclusive . The quality of communication both in the history-taking segment of the visit and during discussion of the management plan was found to influence patient health outcomes . The outcomes affected were , in descending order of frequency , emotional health , symptom resolution , function , physiologic measures ( i.e. , blood pressure and blood sugar level ) and pain control . CONCLUSIONS Most of the studies review ed demonstrated a correlation between effective physician-patient communication and improved patient health outcomes . The components of effective communication identified by these studies can be used as the basis both for curriculum development in medical education and for patient education programs . Future research should focus on evaluating such educational programs The aim of this paper is to assess whether patient-centred consultations are more effective than the usual style of consultations used by general practitioners with patients suffering from benign chronic musculoskeletal pain and fibromyalgia . It also seeks to evaluate the differential characteristics of these two clinical groups of symptoms . The study was design ed as a cluster r and omised and simple blind trial . Twenty general practitioners took part and 110 patients were recruited . Compared with patients who received the usual treatment from their family physician , those who received a patient-centred approach showed greater improvement after 1 year in terms of psychological distress ( anxiety ) and number of tender points , as well as showing positive trends in some important outcomes such as pain intensity . Significantly better results were observed in those patients suffering chronic pain than in those with fibromyalgia , particularly as regards associated symptoms , self-rated pain and physical mobility as measured by the Nottingham health profile Context Some hospitals review a patient 's  hospital record to ascertain adverse events during a recent hospital stay . The accuracy of this procedure is unknown . Asking patients about adverse events is another approach . Contribution The authors surveyed r and omly chosen patients discharged from all hospitals in Massachusetts . Of 998 patients who returned the surveys and gave permission for medical record review , 21 reported severe , potentially preventable adverse events in addition to the 11 such events recorded in the medical record . Caution The surveys took place 6 to 12 months after discharge . Implication Postdischarge patient surveys and medical record review are complementary ways to detect adverse events in the hospital . The Editors Improvements in patient safety depend in part on the ability to measure and monitor injuries to patients . The Institute of Medicine has called for building a national health information infrastructure that would include data about adverse events ( 1 ) , but we lack consensus about the best way to measure adverse events . Common options for reporting adverse events include voluntary and m and atory reporting by providers , automated surveillance of clinical data , administrative data , and record review . Each of these methods has weaknesses ( 14 ) . The medical record is often preferred because of its rich clinical content , but medical record review is expensive , documentation can vary among different clinical setting s , and underreporting may occur because of concern about medicolegal liability ( 5 ) . In recent years , patients have reported about the quality of care in various setting s ( 69 ) . Patients may also be an important source of information about hospital safety . Many hospitals survey patients after discharge to assess their satisfaction with care , so it may be relatively easy to add questions about safety events or symptoms that may suggest the occurrence of an event . Before embarking on such an effort , it would be useful to know what would be gained from the extra effort required . In other words , can patients identify safety events that are not described in the medical record ? If so , what are the characteristics of those events ? We assessed the concordance of adverse events detected by patient interviews with those detected by medical record review , and then characterized the adverse events that were detected by interview but not by medical record review . Methods Sample The sample included patients age 18 years or older who were hospitalized for medical or surgical treatment and were discharged from Massachusetts hospitals from 1 April to 1 October 2003 . We devised a 2-stage probability sample . In the first stage , we grouped the 71 acute care hospitals into 4 strata on the basis of size . We selected the 5 largest hospitals with certainty and allocated the remaining 66 to 3 groups of 22 on the basis of size . Five hospitals were selected from each of the 3 remaining strata , for a total of 20 hospitals . Before data collection began , 4 of the original 20 hospitals withdrew because of re source constraints , leaving 16 hospitals . In the second stage , we r and omly selected 6003 patients from the hospital discharge lists to achieve a final interview target of approximately 3000 patients after projected exclusions and nonresponse . Data Collection Protocol Hospitals supplied patients ' names , contact information , age , date s of hospitalization , and discharge status . Eligible patients received a mailing with a toll-free number to opt out of the interview . Staff at the Center for Survey Research at the University of Massachusetts , Boston , made at least 6 calls before classifying someone as a nonrespondent . Because of delays in obtaining patient lists from the hospitals , interviews took place 6 to 12 months after discharge . Patients gave informed consent orally but had to provide a signed release form to allow us to review their medical records . The study was approved by the institutional review boards at Partners HealthCare System , the Massachusetts Department of Public Health , and each of the study hospitals . We created a firewall to prevent state staff from accessing identifiable data . Question naire We developed a draft question naire after holding focus groups . Initial items were cognitively tested with 10 respondents , followed by a field pretest with 32 persons . In its final form , the interview took about 20 minutes to complete . The first series of questions assessed 4 common categories of hospital treatment or management , including hospital staff administering medicines brought from home , new medicines given in the hospital , diagnostic tests , and surgery . Patients were asked to describe any negative effects or complications while hospitalized . To ensure completeness , we asked 
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RESULTS This study , summarising evidence from 55 studies , indicates consistent positive associations between patient experience , patient safety and clinical effectiveness for a wide range of disease areas , setting s , outcome measures and study design s. It demonstrates positive associations between patient experience and self-rated and objective ly measured health outcomes ; adherence to recommended clinical practice and medication ; preventive care ( such as health-promoting behaviour , use of screening services and immunisation ) ; and re source use ( such as hospitalisation , length of stay and primary -care visits ) .
There is some evidence of positive associations between patient experience and measures of the technical quality of care and adverse events .
Overall , it was more common to find positive associations between patient experience and patient safety and clinical effectiveness than no associations .
The data presented display that patient experience is positively associated with clinical effectiveness and patient safety , and support the case for the inclusion of patient experience as one of the central pillars of quality in healthcare .