🩻Healthcare Quality and Outcomes Unit 11 – Patient-Centered Care & Engagement

What's Patient-Centered Care?

• Approach to healthcare delivery focusing on the individual patient's unique needs, values, and preferences
• Involves active collaboration between patients, families, and healthcare providers to design and manage a customized care plan
• Shifts away from a traditional paternalistic model where the doctor makes all decisions towards a partnership model
• Requires effective communication, empathy, and trust between the patient and the healthcare team
• Aims to improve patient satisfaction, adherence to treatment, and overall health outcomes
  • Considers the patient's cultural background, language, health literacy, and socioeconomic status
  • Involves educating and empowering patients to make informed decisions about their care
  • May include non-traditional therapies or approaches based on the patient's beliefs and values

Why It Matters

• Leads to better health outcomes by ensuring treatments align with the patient's goals and preferences
• Improves patient satisfaction and experience by making them feel heard, respected, and involved in their care
  • Increases likelihood of patients following through with treatment plans and lifestyle changes
  • Reduces anxiety and stress associated with healthcare interactions
• Enhances trust and communication between patients and providers
• Promotes a more efficient and cost-effective healthcare system by avoiding unnecessary treatments or hospitalizations
• Aligns with the ethical principles of autonomy, beneficence, and non-maleficence
• Contributes to reducing healthcare disparities by tailoring care to the individual's unique needs and context
• Supports a more holistic approach to health and well-being beyond just treating disease

Key Principles

• Respect for patient's values, preferences, and expressed needs
• Coordination and integration of care across the healthcare continuum
• Information, communication, and education to enable informed decision-making
• Physical comfort and emotional support to alleviate fear and anxiety
• Involvement of family and friends as desired by the patient
• Continuity and transition to ensure seamless care across settings and over time
• Access to care that is timely, convenient, and affordable

Strategies for Patient Engagement

• Shared decision-making involves the patient and provider collaboratively making treatment decisions based on the best available evidence and the patient's values
• Patient education and health literacy initiatives help patients understand their conditions, treatment options, and self-management strategies
  • May include written materials, videos, online resources, or in-person classes
  • Should be tailored to the patient's language, culture, and learning style
• Motivational interviewing is a counseling approach that helps patients identify and resolve ambivalence about behavior change
• Patient-reported outcomes (PROs) capture the patient's perspective on their health status, symptoms, and quality of life
  • Can be used to monitor progress, adjust treatment plans, and inform quality improvement efforts
• Patient and family advisory councils provide a forum for patients and families to share their experiences and provide input on healthcare policies and practices
• Remote monitoring and telehealth technologies enable patients to manage their health at home with support from their healthcare team

Challenges and Barriers

• Time constraints and competing demands in busy healthcare settings can limit opportunities for meaningful patient engagement
• Healthcare provider attitudes, biases, and lack of training in patient-centered communication skills
• Patient factors such as low health literacy, language barriers, cultural differences, and mistrust of the healthcare system
• Fragmentation and lack of coordination across the healthcare continuum
• Financial barriers such as high out-of-pocket costs or lack of insurance coverage for certain services or technologies
• Regulatory and legal issues around data privacy, informed consent, and shared decision-making
• Resistance to change among healthcare organizations and professionals accustomed to traditional models of care

Tools and Technologies

• Electronic health records (EHRs) can facilitate information sharing, care coordination, and patient access to their health information
  • Patient portals allow patients to view test results, request prescription refills, and communicate with their healthcare team
  • Interoperability standards enable data exchange across different EHR systems and care settings
• Decision aids are tools that help patients understand their options and make informed choices based on their values and preferences
  • May include videos, interactive websites, or printed materials comparing the risks and benefits of different treatments
• Mobile health (mHealth) apps can support patient self-management, behavior change, and remote monitoring
  • Examples include medication reminders, symptom trackers, and fitness apps
• Wearable devices and sensors can collect real-time data on patient's vital signs, activity levels, and other health indicators
• Artificial intelligence (AI) and machine learning algorithms can analyze patient data to personalize treatment recommendations and predict risk

Measuring Success

• Patient satisfaction surveys and experience measures (e.g., HCAHPS) assess the patient's perception of the quality of care they received
• Patient engagement metrics such as shared decision-making, patient activation, and self-management skills
• Clinical outcomes such as symptom control, functional status, and quality of life
• Utilization measures such as emergency department visits, hospital readmissions, and length of stay
• Process measures such as medication adherence, preventive screening rates, and care coordination
• Cost and efficiency measures such as total cost of care, resource utilization, and value-based payment models
• Population health indicators such as health equity, disparities reduction, and community well-being

Real-World Examples

• The OpenNotes initiative allows patients to access their clinical notes online, promoting transparency and patient engagement
• The Patient-Centered Medical Home (PCMH) model organizes primary care around the patient's needs, with a team-based approach and enhanced access and coordination
• The Choosing Wisely campaign educates patients and providers about avoiding unnecessary tests and treatments that may cause harm or waste resources
• The National Quality Forum (NQF) has developed a framework for measuring patient-reported outcomes (PROs) across various conditions and settings
• The Institute for Patient- and Family-Centered Care (IPFCC) provides resources and training to help healthcare organizations implement patient-centered practices
• The Centers for Medicare and Medicaid Services (CMS) has launched several initiatives to promote patient-centered care, such as the Hospital Value-Based Purchasing (VBP) program and the Merit-based Incentive Payment System (MIPS) for clinicians