Patient enablement is a possible outcome of primary health care consultations and has been employed as a marker of effective helpgiving. We studied predictors of patient enablement, investigating the relative contribution of patient characteristics (gender, age, occupational status, and perceived health status), visit characteristics (length of consultation, duration of physician-patient relationship, and frequency of consultations), and the physician's reported helpgiving style (level of encouragement of patient participation in the consultation). The Helpgiving Practices Scale and Patient Enablement Instrument were completed by 103 patients from eight metropolitan general practices. Patients with better perceived health status and lower occupational status felt more enabled following their consultations. Frequency of consultations employed as a measure of "knowing a doctor well" was also significantly associated with post-consultation enablement. General practitioners' encouragement of patients to participate in their health care then added significantly to the explained variance in patient enablement. Results of this study indicate that the Patient Enablement Instrument is a useful measure of quality of care with scores being less positively skewed than those of frequent employed satisfaction measures.

crowding levels. We then compared the adoption of crowding measure across quartiles and compared differences using linear regression using 2010 data. All analyses were adjusted for complex survey design and weighting to provide national estimates (SAS 9.3); P<.05 was significant. Results: There was a significant increase for seven crowding interventions from 2007 to 2010 including use of bedside registration (66.3% in 2007 to 79.2% in 2010, P¼.0019), electronic dashboards (35.2% to 51.9%, P¼.0024), radio frequency identification tracking (9.8% to 20.7%, P¼.0216), full capacity protocol (21.0% to 45.6%, P<.001), boarding patients on inpatient hallways (14.8% to 23.8%, P¼.027), immediate bed census availability (66.1% to 83.4%, P<.0001), and use of pooled nurses (33.2% to 60.0%, P<.0001). The total number of interventions rose from 5.2 to 6.6 from 2007 to 2010 (P<.0001). Several crowding interventions demonstrated no change over the study period, such as computer-assisted triage, presence of fast-track, increased number of standard ED treatment spaces, physical expansion of the ED, zone nursing, use of a bed czar, avoiding admissions when on ambulance diversion, presence of a separate OR for ED cases, or surgical schedule smoothing. The use of an ED observation unit decreased (35.7% to 21.1%, P<.0001). In 2010, six specific interventions showed greater use in more crowded EDs (Table). By comparison, use of bed census availability and avoiding admissions of elective cases during ambulance diversion were inversely related to ED crowding. Adoption of the remainder of the interventions was not associated with ED crowding levels. Conclusion: There has been a growth in the number of interventions to reduce ED crowding across U.S. hospitals from 2007-2010, several which reflect technological advances. However, interventions that required a change in hospital-level protocols demonstrate relatively low adoption rates and have not grown in use, potentially because of difficulties in accomplishing hospital-wide interventions or priorities. In general, EDs that were more crowded have adopted more strategies, demonstrating that interventions are being used in hospitals with the greatest need.