Abstract / Summary
Abstract Objective Patient-centered care (PCC) and continuity of care (COC) are both promoted as quality indicators, yet it remains unclear whether these experiential and structural dimensions of care show different pathway patterns for patient-reported outcomes in diabetes. This study examined their associations with health-related quality of life (HRQoL) and satisfaction among patients with type 2 diabetes, and whether these associations involved patient activation and adherence pathways. Methods We conducted a cross-sectional survey of 1,394 patients with type 2 diabetes across six hospitals in northern Taiwan in 2016. PCC and COC (patient-reported Bice-Boxerman index) were modeled as care-related predictors; patient activation, assessed using the Patient Activation Measure, and adherence, assessed using a 7-item composite of medication-taking and completion of recommended diabetes examinations, were modeled as intermediate variables; HRQoL (EQ-5D-5L) and satisfaction were the outcome. Path analysis was performed in Stata with maximum likelihood estimation, adjusting for sociodemographic and clinical covariates; hospital-clustered robust standard errors were used to account for patients nested within hospitals. Unstandardized direct, indirect, and total effects with 95% confidence intervals were derived from the hospital-clustered model. Results With PCC and COC as care-related predictors, patient activation and adherence as intermediate variables, and HRQoL and satisfaction as outcomes, autonomy support and information/education/communication were positively associated with patient activation and patient satisfaction. Both domains showed significant direct and indirect associations through patient activation with satisfaction, with total effects of 0.1805 and 0.3607, respectively (both P < 0.001). Continuity of care was positively associated with patient activation (b = 0.1384, P < 0.001), adherence (b = 0.4367, P = 0.044), and satisfaction (total effect b = 0.1708, P = 0.004). Patient activation was positively associated with satisfaction and HRQoL, whereas adherence was positively associated with HRQoL. Continuity of care was indirectly associated with HRQoL primarily through adherence (combined indirect effect b = 0.0121, P < 0.001). Information/education/communication showed a negative direct association but a positive indirect association with HRQoL, resulting in a nonsignificant total effect. Conclusions PCC and continuity of care showed complementary, outcome-specific pathway patterns. PCC-related indirect associations with HRQoL were activation-related, whereas continuity of care was associated with HRQoL primarily through adherence; both were associated with satisfaction through direct and activation-related pathways.