Patient-Centric Care Management Is a Strong Strategy

patient-centric-care-managementFormalizing care management is an important contribution to a culture of quality healthcare. This field integrates vital aspects of quality management in healthcare, such as quality planning, assurance, and monitoring processes. It is exemplified through a culture of continuous improvement and supported by a technology platform specifically designed for the task.

Care management establishes criteria to identify persons with a high risk for serious medical problems who could benefit from interventions by a good care management team. These trained teams address the needs of their assigned patients and build relationships of trust and communication with patients and their families, as well as with their healthcare providers and staff. This is the critical component of patient-centric care management.

Let’s take a closer look at these elements of effective care management.

A Culture of Continuous Improvement

While care management is a specific example of a field that contributes to a foundation for quality healthcare, every healthcare organization needs an underlying structure for continuous improvement and success. In a previous article, I addressed the importance of the three systems that lead to outcomes improvement: Best Practice, Analytics, and Adoption. Organizations, such as Texas Children’s Hospital, have used this model to achieve remarkable improvements in various areas. Texas Children’s has seen impressive results in its diabetic patient cohort, including a significant decrease in the percent of patients with recurrent diabetic ketoacidosis encounters and formidable improvements in several key follow-up metrics. Texas Children’s has developed a strong quality culture, promoted by the leadership in its quality department and by other executives and staff throughout their governance structure.

Care Management Technology

Technology to facilitate the functions and processes of care management is becoming more and more essential to ensuring timely and quality healthcare for all patients. This technology includes having real-time data to identify and stratify high-risk patients, assign them to care management teams, automate reminders, monitor patient status, and facilitate patient communication with members of the care management team.

Health Catalyst’s Care Management Suite is one example of a technology platform that supports the objectives of care management teams, and contributes to an overall culture of quality in the healthcare arena.

Patient Case vs. Patient Centered

A persistent, patient-centric focus is one of the most significant capabilities behind appropriate care management. Yet there is an ease with which we lose this focus.

Years ago, when I was rotating through several medical departments while in training, one of my mentors was a brilliant neurosurgeon. I was in awe of his surgical abilities, and how quickly he would perform procedures, such as cervical laminectomies. Speed seemed to characterize most everything that he would do, and so those of us under his supervision appreciated the time he would take from his busy schedule to patiently teach us details beyond those found in textbook medicine. One disconcerting trait we noticed, however, was that he sometimes severely limited his communication with hospital patients. Without adequate warning, he would proceed to evaluate their reflexes through actions such as poking the bottom of their feet with a semi-sharp instrument. We wondered how such a renowned specialist could have this type of bedside manner.

In contrast, Dr. Jack Stevens, an Internal Medicine mentor at the same hospital, prioritized patients…and people in general. At the same time, he was an outstanding clinician. Some of the leading physicians in the local medical community were his patients. It is humorous to note that this fact destroyed a rare attempt by an attorney to accuse Dr. Stevens of malpractice. The attorney presented a list of prominent physicians to establish the community medical standard against which he wished to compare Dr. Stevens. The attorney was left speechless, and without a strong case, when Dr. Stevens responded that “Yes, they are all my patients!”

As I observed Dr. Stevens work with his patients, it became obvious immediately how much they appreciated his compassionate bedside manner. I especially remember one female patient whom he had been following for several years. She would open up to Dr. Stevens about issues in her life that had impacted her medical situation, which she hadn’t wanted to share with anyone else. It was obvious how much she appreciated the time he spent talking with her in such a caring way, especially considering that she had been alone at home, where she had given up on life and would not get out of bed. After this admission, we learned she had a metastatic cancer that had infiltrated her lower extremity lymphatic system, so her passing away was not a surprise. But I was moved as I reflected on how this patient’s last few days, instead of spending them at home alone in bed, were enhanced by Dr. Stevens’ improving the quality of her life. It should also be mentioned that he knew of this patient’s home situation through personal, periodic follow-ups, in what today would be considered good care management principles.

Above All, a Patient-Centric Focus

No combination of methods, tools, and techniques is complete without the essential principle of a patient-centric focus throughout. This focus empowers the healthcare professional to leverage available resources in a manner best suited for each patient’s well-being, including bridging cultural and language barriers that can impede outstanding treatment to meet the patient’s needs.

Having worked as a physician in both the U.S. and Mexico, I am acutely aware of significant challenges presented by the respective differences in culture and language. The average English-speaking patient, for example, may understand the medical term “scapula,” but most likely calls it a “shoulder blade.”  Likewise, it is common to hear the Spanish word “paleta” (literally, “paddle”) among Spanish-speaking natives, rather than the words “escápula” and “omóplato,” which are the more educated terms. Healthcare professionals need to be familiar with the variety of terms that might be employed to ensure they understand the patient’s condition and treat appropriately.

Similarly, the culture where one practices, influences how one practices. For example, legal pressures in the U.S. promote a significant overutilization of lab tests. However, I know from personal experience that, in Mexico, socioeconomic conditions discourage ordering any but the most essential lab tests. Instead, the culture promotes a greater dependency on the clinician’s ability to do quality histories and physicals to arrive at a precise diagnosis and treatment plan. Neither approach seems to be ideal, but in a patient-centric world, these cultural pressures become subservient, and healthcare tailored to the patient’s needs predominates.

Care Management Requires a Multidimensional Approach

The basics of care management include both complex and simple requirements: a culture of continuous improvement, a technology platform to support this culture, and the care management teams that put the patient at the center of everything.

In her book on preparing for the PMP Exam, Rita Mulcahy wrote that quality is the degree to which requirements are fulfilled. If we are to nourish a culture of continuous improvement in healthcare, then we must keep a patient-centric focus by always fulfilling patients’ requirements, as exemplified by Dr. Stevens in his medical practice. This cannot be achieved immediately, but it can come through cycles of continuous improvement at both individual and organizational levels. And now we have the technology platform—the EDW and specific applications—to assist care management teams with a data-driven structure for navigating this new field.

It is exciting to see the progress already being made toward having this patient-centric culture of quality permeate all facets of healthcare, and to be a participant together with many others in striving toward this great achievement.

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