Patient-Centered Healthcare: Why Health Systems Need to Move Beyond Sick Care

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patient centered healthcareEditor’s note: This mini lesson represents some of the content presented at Health Catalyst University’s Accelerated Practices (AP) Program. With the purpose of educating health professionals, the AP Program prepares healthcare teams to accelerate outcomes improvement. Faculty and guest experts of the program are recognized leaders in their respective fields of expertise. Below, Dr. Bryan Oshiro, Health Catalyst University’s Accelerated Practices (AP) Program Director, shares insight about the role of patient-centered care in transforming our ailing healthcare system—a topic he covers in his session on curing versus caring.

“Sick care.” This is the care you can expect to receive when you become ill or have an emergency. It’s the way our healthcare system is currently designed—and it works like this: after you get sick, the provider’s role is to administer a treatment to help you return to as healthy a state as possible. And while this type of restorative medicine is necessary, patients could avoid many illnesses and diseases in the first place if they received patient-centered healthcare—care with a focus on appropriate primary care and preventative measures.

Pitfalls of Sick Care: Increased Risk of Harm and High Costs

I’d like to point out: our sick care system does offer some value because it saves lives. Disease, illness, and accidents are not always avoidable. But keeping the current focus on restorative care won’t help health systems significantly improve care—or reduce costs. In fact, treating medical conditions after they set in introduces a new type of risk for patient. This is because almost all treatments have the potential to cause even more patient harm.

Sick care is also a costly approach to care delivery because it imposes a considerable financial burden on society. As documented in this report by the Commonwealth Fund, Americans spend more on healthcare than any other industrialized country (e.g., Sweden, Germany) in the world. Yet, we are sicker and have shorter lifespans than do citizens of other industrialized countries.

Because of these less-than-optimal patient outcomes and the high costs of providing sick care, both the U.S. government and the healthcare industry are working diligently to improve the existing system of care.

4 Ways to Transform Our Ailing Healthcare System

Solving the nation’s healthcare cost and quality problems is possible, but it won’t happen overnight. Instead, health systems should plan on a journey of transformation to high-value healthcare. This journey will include changes and improvements to the way they’re used to operating. In particular, the following four improvements should form the basis of every health system’s improvement strategy:

  1. Waste reduction and elimination (e.g., reduction of preventable complications, unnecessary treatments, inefficiencies, errors) and a focus on the services that add value
  2. Delivery of safe care
  3. Delivery of cost-effective care
  4. Delivery of clinically sound, evidence-based care

In addition to these four improvement opportunities, a newer solution is proving its value in transforming our costly system of sick care to a more sustainable model of care. It’s called patient-centered care.

A New Model of Care: Patient-Centered Care

Patient-centered care is a preventative approach to patient care that originates with primary caregivers. Their role is to build relationships with their patients, engage patients to take more responsibility for their own health outcomes, and encourage patients to adopt a proactive approach to preventing future illnesses.

With patient-centered healthcare, primary caregivers also become responsible for providing care according to the needs and wishes of their patients. This is different from providing care based strictly on a clinical assessment of the situation. As defined by the Institute of Medicine’s Crossing the Quality Chasm report, patient-centered care is “care that is respectful of and responsive to individual patient preferences, needs, and values, and ensures that patient values guide all clinical decisions.”

The 8 Elements of Patient-Centered Care

There are eight elements that define an organization’s ability to provide patient-centered care. They include:

  1. Respecting patients’ preferences, values, and desire to stay informed
  2. Providing emotional support for patients’ concerns (e.g., anxiety)
  3. Ensuring patients’ physical comfort is managed (e.g., pain management)
  4. Informing and educating patients about their condition(s)
  5. Ensuring continuity of care and transitional assistance after patients are discharged
  6. Coordinating and integrating care between care providers, hospitals, and/or clinics
  7. Enabling of patients to access to care whenever care is needed
  8. Including family and friends as caregivers and decision makers

Patient-Centered Care to Improve Cost, Quality, and Satisfaction

Providing patient-centered care is important in this environment of accountable care because of the gains in cost, quality, and patient satisfaction this model of care offers. Let’s take, for example, a chronic disease like diabetes. According to the CDC’s site, chronic diseases are the leading cause of death and disability in the United States. “Diabetes, in particular, is the leading cause of kidney failure, nontraumatic lower-limb amputations, and new cases of blindness among adults in the United States,” states the CDC’s National Diabetes Fact Sheet, 2011.

Many complications associated with diabetes can be averted, though, if a primary care provider administers proper preventative measures and the patient adopts healthy lifestyle changes (e.g., increasing physical activity, improving nutrition, quitting smoking, reducing alcohol consumption). This approach applies to many chronic diseases that, like diabetes, can be successfully treated—and even eliminated with proper care. As a result, providers order fewer tests, patients spend less time in the hospitals, and costs decrease for patient, provider, and payer.

Looking to the Future of Care Delivery

Achieving patient-centered care is a goal for many healthcare organizations because they’re recognizing its value as they work to improve patient care and outcomes. And while many health systems already provide some aspects of this new model of care (e.g., care coordination or enabling access to care), achieving all eight dimensions will require a shift in the way clinicians and organizations currently deliver care. It’s important for them to make this transition, though, because staying with the current model of sick care will only serve to limit an organization’s ability to meet the goals of the Triple Aim.

What is your experience using patient-centered care?

Key Takeaways

  • There are four basic approaches to improving care and reducing costs:
    1. Eliminating waste (e.g., preventable complications, unnecessary treatments, inefficiencies, errors) and focusing instead on the services that add value
    2. Providing cost-effective care
    3. Providing clinically sound, evidence-based care
    4. Providing safe care
  • Patient-centered care, a newer approach to care delivery, is a key solution in the transformation of America’s costly system of sick care to a more sustainable model of care.
  • There are eight elements that form the foundation of patient-centered care:
    1. Respecting patients’ preferences, values, and desire to stay informed
    2. Providing emotional support for concerns such as anxiety
    3. Ensuring patients’ physical comfort is managed (e.g., pain management)
    4. Informing and educating patients about their condition(s)
    5. Ensuring continuity of care and transitional assistance after being discharged
    6. Coordinating and integrating care between care providers, hospitals, or clinics
    7. Enabling access to care whenever care is needed
    8. Including family and friends as care givers and decision makers

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