What is patient-centered care?

What is patient-centered care? – NEJM Catalyst – January 1, 2017

In patient-centered care, an individual’s specific health needs and desired health outcomes are the driving force behind all health care decisions and quality measurements.

That would be “nice”, but these days money is the driving force – and personalized care can be expensive.

Patients are partners with their health care providers, and providers treat patients not only from a clinical perspective, but also from an emotional, mental, spiritual, social, and financial perspective.   

Elements of Patient-Centered Care

Patient- and family-centered care encourages the active collaboration and shared decision-making between patients, families, and providers to design and manage a customized and comprehensive care plan.

Most definitions of patient-centered care have several common elements that affect the way health systems and facilities are designed and managed, and the way care is delivered:

  • The health care system’s mission, vision, values, leadership, and quality-improvement drivers are aligned to patient-centered goals.
  • Care is collaborative, coordinated, and accessible. The right care is provided at the right time and the right place.
  • Care focuses on physical comfort [this should include pain relief] as well as emotional well-being.
  • Patient and family preferences, values, cultural traditions, and socioeconomic conditions are respected.
  • Patients and their families are an expected part of the care team and play a role in decisions at the patient and system level.
  • The presence of family members in the care setting is encouraged and facilitated.
  • Information is shared fully and in a timely manner so that patients and their family members can make informed decisions.

Benefits of Patient-Centered Care

The primary goal and benefit of patient-centered care is to improve individual health outcomes, not just population health outcomes, although population outcomes may also improve.

We have been standardizing treatment of individuals according to population statistics. This is a common fallacy:

  • Even when 50% of the population is male and 50% female, that doesn’t mean that each individual is 50% male and 50% female.
  • The average American family size is now 3.14 people (according to Siri), but no particular family can be that size.

So you can easily see that population statistics do not apply to individuals!

Yet that’s what legislators are trying to do with all these new limits on prescribing opioids. Basing our medical care on such misleading population data can be downright harmful to any specific individual.

Not only do patients benefit, but providers and health care systems benefit as well, through:

  • Improved satisfaction scores among patients and their families.
  • Enhanced reputation of providers among health care consumers.
  • Better morale and productivity among clinicians and ancillary staff.
  • Improved resource allocation.
  • Reduced expenses and increased financial margins throughout the continuum of care.

Patient-Centered Care Examples

Patient-focused care is realized in a number of ways, across a variety health care settings, from family care and specialty providers, to acute, emergency, and long-term care providers. Here are a few examples.

Patient-centered care in the doctor’s office.

Under patient-centered care, care focuses more on the patient’s problem than on his or her diagnosis. Patients have trusted, personal relationships with their doctors in patient-focused care models.

While human interaction takes a primary role in patient-centered care, physician practices may also employ a variety of technology-based tools to help patients take ownership of their health care outside of the doctor’s office.

These aspects of care are disappearing as human interactions take more time (and are thus more expensive) than standardized algorithms applied equally and indiscriminately to all patients.

Patient-centered care in the hospital.

Patients are given the authority to identify who can visit and when. Family members (as defined by the patient and not limited to blood relations) are invited to visit during rounding and shift changes so they can be part of the care team, participating in discussions and care decisions

When not in the room with the patient, they are kept informed of their loved one’s progress through direct and timely updates. A patient-centered care hospital’s infrastructure encourages family collaboration through a home-like environment that not only meets the needs of the patient, but also meets the needs of family members.

Personalized medicine.

The concept of patient-centered care extends to the treatments and therapies clinicians provide. Not only are care plans customized, but medications are often customized as well.

No, they are not. Especially medications (types and dosages) are now determined by standards set by the corporation that the doctors are working for.

We can see in the botched CDC Opioid Guideline that standardized doses determined by population statistics are being applied, and even legislated, for all.

A patient’s individual genetics, metabolism, biomarkers, immune system, and other “signatures” can now be harnessed in many disease states — especially cancer — to create personalized medications and therapies, as well as companion diagnostics that help clinicians better predict the best drug for each patient.

I don’t see this happening at all and pain management is going in the opposite direction.

Cultural Shift to Patient-Centered Care

patient-centered care requires a shift in the way provider practices and health systems are designed, managed, and reimbursed.

And there are too many making too much profit in the current system, and they will fight to the death to keep the system that enriches them in place.

Patient-centered care also represents a shift in the traditional roles of patients and their families from one of passive “order taker” to one of active “team member.”

One of the country’s leading proponents of patient-centered care, Dr. James Rickert, has stated that one of the basic tenets of patient-centered care is that “patients know best how well their health providers are meeting their needs.

Yes, we do, but no changes result from our complaints.

Instead, we are manipulated to believe we are “being taken care of” by glitzy surroundings (a lot of glass and wood) and unnecessary luxury offerings (aromatherapy, massage) and the wording of questions on “consumer satisfaction” surveys (no more questions about whether pain was managed well).

To that end, many providers are implementing patient satisfaction surveys, patient and family advisory councils, and focus groups, and using the resulting information to continuously improve the way health care facilities and provider practices are designed, managed, and maintained from both a physical and operational perspective so they become centered more on the individual person than on a checklist of services provided

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