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The Definition of Patient Centered Health Care, Courtesy of Health Affairs

Posted Aug 15 2010 8:25am
When Disease Management Care Blog readers were wondering just what the literature had to say about the catchphrase "care management," they were in luck . When readers wanted to know more about the policy underlying Accountable Care Organizations, the DMCB responded . Health insurance exchanges? No problem . The same is now true for the term "patient centered (medical) healthcare," courtesy of Ronald Epstein, Kevin Friscella, Cara Lesser and Kurt Strange writing in the August issue of Health Affairs .

Quoting the IOM's Quality Chasm report , the authors define it as any care that is "respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions."

This means the system has to promote doctor-patient relationships that are
1) a two way relationship, where the patient's responsibility is to learn about the disease and share his/her preferences, while the providers have to embrace the patient's values, beliefs, hopes and ways of dealing with adversity. Ultimately, consensus is achieved.

2) enriched by teaming, since no single provider can manage it all.

3) reliant on "framing," in which the health care providers "tailor" the information they provide in response to patient literacy, concerns, beliefs and expectations

4) deliberative, because expectations and circumstances change over time.

Why is this necessarily a good thing? The authors argue it's not only the "right thing to do," but quote studies suggesting that it is associated with improved care (quality), improved well-being (quality of life), reductions in disparities, lower costs, fewer allegations of malpractice and increases in patient safety.

To make it happen, the authors have suggestions for measurement (using a combination of tools that go beyond mere patient surveys) health information technology (better access to patient-centric information), "informed flexibility" in the organization of health care (more than just policy, procedures and protocols) and the support of collaborative " loosely affiliated communities of care ."

Very helpful, says the DMCB, because
1. When it and any other member of the disease management industry writes, quotes, brands, markets, extols, points to or describes "PCHC," it can point to a reference from a credible scientific resource*,

2. While the article relies on 57 references to describe patient-centered healthcare, a close examination of that literature fails to show that there have been any prospective randomized trials on the topic. It's correct - yet ironic - that the authors have not issued a call for comparative effectiveness research. It's better to think about how, not if, PCHC should be adopted in the mainstream of medical care. One answer to that lies in the disease management industry, because of number 3.....

3) The authors correctly salute the "community" of health care that can surround a patient in PCHC, which is precisely analogous to the medical "neighborhood," "village" and "ecosystem" that has been described as a key virtue of a population-based care management system working to support the patient centered medical home . Why not? There's evidence that patient-centeredness is has been an ingredient of disease management all along .

*Epstein RM, Friscella K, Lesser CS, Stange KC: Why the nation needs a policy push on patient centered health care. Health Affairs 2010;29(8):1489-1495
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