If You Build It, Will They Come? Designing Truly Patient-Centered Health Care

Bechtel, Christine; Ness, Debra L.

doi:10.1377/hlthaff.2010.0305

Cited by 146 publications

(117 citation statements)

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“…Effectively implementing patient-centered care requires a thorough evaluation of its impact on patients, including an understanding of patients' perceptions [14][15]. In an analysis of health care organizations that implemented patient-centered care initiatives, Luxford and colleagues found that going beyond conventional frameworks to engage patients was essential [16].…”

Section: Introductionmentioning

confidence: 99%

Using Photovoice to Explore Patient Perceptions of Patient-Centered Care in the Veterans Affairs Health Care System

Balbale

Morris

LaVela

2014

Patient

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Background-Accounting for patient views and context is essential in evaluating and improving patient-centered care initiatives, yet few studies have examined the patient perspective. In the Veterans Affairs (VA) Health Care System, several VA facilities have transitioned from traditionally disease-or problem-based care to patient-centered care. We used photovoice to explore perceptions and experiences related to patient-centered care among Veterans receiving care in VA facilities that have implemented patient-centered care initiatives.

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Section: Introductionmentioning

confidence: 99%

Using Photovoice to Explore Patient Perceptions of Patient-Centered Care in the Veterans Affairs Health Care System

Balbale

Morris

LaVela

2014

Patient

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“…PCC encompasses a number of key concepts, each capturing a distinct measurable facet of the patient health care experience that can be directly assessed. These concepts include: patient activation; 6,7 shared patient/provider decisionmaking; 8,9 empathy and holistic care in the patient-provider relationship; 6,7 chronic care delivery; 10 and timely, accessible care that meets patient's needs, preferences, and results in optimal satisfaction. 6,9 A variety of measures can be used to assess impacts of PCC and patient experiences on health care quality, including preventive care screenings, e.g., breast, cervical and colorectal cancer screening; 11 chronic condition care and management, e.g., appropriate tests of (and abnormal tests results for) common chronic conditions like diabetes [11][12][13][14] and hypertension; [11][12][13] and emergency room (ER) and inpatient (IP)…”

mentioning

confidence: 99%

Assessing the Associations of Patient-Reported Perceptions of Patient-Centered Care as Supplemental Measures of Health Care Quality in VA

2016

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BACKGROUND: Patient-reported experience measures (PREMs) are useful for assessing health care quality and safety and patients' perceptions of health care. OBJECTIVE: We aimed to assess the relationship between PREMS [e.g., measures of patient-centered care (PCC)] and health care quality metrics. DESIGN: We conducted a national survey via mail. Survey data were supplemented with US Department of Veteran Affairs (VA) administrative data. PARTICIPANTS: Veteran (n = 5512) VA health care users participated in the study. MAIN MEASURES: PCC measures included: patient activation; shared decision-making (SDM); empathy and holistic care; chronic illness care; perceptions of participation, respect for choices, and support; and overall health care experience. Health care quality measures included: preventive care screening receipt; chronic condition management (diabetes, hypertension); and health care utilization (hospitalizations, emergency room (ER) visits). Analyses included: bivariate comparisons of PCC measures by health care quality measures; and multivariate linear regression to identify variables associated with attaining multiple positive health care quality indicators (when controlling for potential confounders). KEY RESULTS: PREMs assessing factors relating to patient-provider communication (e.g., empathic provider care, shared decision-making) are mainly related to clinical indicators representing good chronic condition management, while those relating more broadly to health care in general (e.g., patient activation, chronic illness care) are mainly related to measures of appropriate health care use (e.g., preventive care screening receipt; potentially avoidable hospitalizations; unscheduled care, such as ER visits). When controlling for potential confounders, higher perceptions of the decision-making effectiveness component of SDM (β = 0.004, p = 0.03) and empathy and holistic care (β = 0.01, p = 0.02) showed a weak but positive relationship with attaining a greater number of positive health care quality indicators, while a weak but negative relationship emerged for perceptions of participation, respect for choices, and support (β = −0.003, p = 0.03) and overall VA experiences (β = −0.10, p = 0.04). CONCLUSIONS: PREMs that measure PCC offer rich data about health care quality while engaging patients, and considering patient experiences and preferences, in performance assessment. PREMs may be used to supplement existing performance metrics.KEY WORDS: patient-centered care; patient engagement; performance measurement; quality assessment.

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“…4 Patients want their clinicians to take a holistic, rather than a disease-based, approach to their care and coordinate and communicate it across care settings. 92 The current system of uncoordinated, sequential visits to multiple clinicians, departments and specialties works against value. Instead, integrated, team-based practice units are needed that encompass all essential skills and services required over the full cycle of care for common medical conditions and their related comorbidities.…”

Section: Convert Health Care Institutions Into Rapidly Learning Organmentioning

confidence: 99%

Ten clinician-driven strategies for maximising value of Australian health care

Scott¹

2014

Aust. Health Review

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Objective. To articulate the concept of high-value care (i.e. clinically relevant, patient-important benefit at lowest possible cost) and suggest strategies by which clinicians can promote such care in rendering the Australian healthcare system more affordable and sustainable.Methods. Strategies were developed by the author based on personal experience in clinical practice, evidence-based medicine and quality improvement. Relevant literature was reviewed in retrieving studies supporting each strategy.Results. Ten strategies were developed: (1) minimise errors in diagnosis; (2) discontinue low-or no-value practices that provide little benefit or cause harm; (3) defer the use of unproven interventions; (4) select care options according to comparative cost-effectiveness; (5) target clinical interventions to those who derive greatest benefit; (6) adopt a more conservative approach nearing the end of life; (7) actively involve patients in shared decision making and self-management; (8) minimise day-to-day operational waste; (9) convert healthcare institutions into rapidly learning organisations; and (10) advocate for integrated patient care across all clinical settings.Conclusions. Clinicians and their professional organisations, in partnership with managers, can implement strategies capable of maximising value and sustainability of health care in Australia.What is known about this topic? Value-based care has emerged as a unitary concept that integrates quality and cost, and is being increasingly used to inform healthcare policy making and reform. What does this paper add? There is scant literature that translates the concept of high value care into actionable enhancement strategies for clinicians in everyday practice settings. This article provides 10 strategies with supporting studies in an attempt to fill this gap. What are the implications for practitioners? If all practitioners, in partnership with healthcare managers, attempted to enact all 10 strategies in their workplaces, a significant quantum of healthcare resources could be redirected from low-to highvalue care, culminating in much greater health benefit from the healthcare dollars currently being spent. However, such reforms will require a shift in clinician thinking and practice away from volume-based care to value-based care.

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If You Build It, Will They Come? Designing Truly Patient-Centered Health Care

Cited by 146 publications

References 10 publications

Using Photovoice to Explore Patient Perceptions of Patient-Centered Care in the Veterans Affairs Health Care System

Using Photovoice to Explore Patient Perceptions of Patient-Centered Care in the Veterans Affairs Health Care System

Assessing the Associations of Patient-Reported Perceptions of Patient-Centered Care as Supplemental Measures of Health Care Quality in VA

Ten clinician-driven strategies for maximising value of Australian health care

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