In my previous posts, I've discussed the benefit of integrating the three macro processes of the PCLC Value Chain strategy: emergency-care, sick-care & well-care. In my next series of posts, I'm going to focus on our healthcare system's problematic clinical and financial processes. I'll be examining ways to reform these processes so they enable the PCLC Value Chain strategy to succeed in increasing increase healthcare effectiveness, efficiency and access. I begin with the transformation to "patient-centered" care.
Patient-Centered Care To define patient-centered care, let's start by contrasting it with the kind of non-patient-centered care we have today. We currently have a fragmented healthcare system in which:
The following six core elements are identified most frequently in the literature as essential for patient-centered care:
Patient-Centered Medical Home One implementation of patient-centered healthcare is the "advanced medical home"--also called a "patient-centered medical home"--which is:
...a model of care that puts the needs of the patient first. The medical home is the base from which health care services are coordinated to provide the most effective and efficient care to the patient. This includes the use of health information technology, the coordination of specialty and inpatient care, providing preventive services through health promotion, disease management and prevention, health maintenance, behavioral health services, patient education, and diagnosis and treatment of acute and chronic illnesses...Each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care. The medical home is responsible for providing for all the patient's health care needs or taking responsibility for appropriately arranging care with other qualified professionals. The personal physician leads a team of individuals who collectively take responsibility for the ongoing care of patients...Quality and safety are the hallmarks of the medical home. Evidence based medicine, health information technology, and clinical decision support tools guide decision making to support patient care, performance measurement, patient education, and enhanced communication. Ensuring the coordination and comprehensive approach of the medical home model over time will improve the efficiency and effectiveness of the health care system and ultimately improve health outcomes.The above definition describes the kind of highly functional patient-centered medical home that is most closely aligned with the PCLC Value Chain and of greatest benefit to patients. Unfortunately, few exist today. But if we "water down" the definition to mean little more than a regular doctor or source of primary care who (a) has information about patients' medical history, (b) can be contacted by phone during office hours, and (c) coordinates care--then more exist, though not nearly enough. While the benefits to patients are not as great with this less functional type medical home, it can still help improve outcomes and value to the patient; consider the following:
Cross-national and U.S.-specific studies find an association between access to comprehensive primary care and both better health outcomes and lower medical costs. In light of such evidence, a movement has emerged to transform primary care practices into "medical homes" that provide an array of patient services in an efficient manner…[but] only about half of adults in all seven countries have medical homes. In each country, patients with medical homes reported more positive care experiences than those who did not, including more time spent with their doctors and greater involvement in care decisions.The delivery of patient-centered care, including the extensive use highly functional medical homes, is therefore one systemic reform process that would bring value to the patient. In my next post, I discuss another: Value-Based Competition.
 Shaller, D. (October 2007) Patient-Centered Care: What Does It Take?, The Commonwealth Fund, Volume 74. Available at http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=559715
Available at http://wellness.wikispaces.com/Tactic+-+Implement+the+Advanced+Medical+Home+Mode
Available at http://www.patientcenteredprimarycare.org/medicalhome.htm
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