Patient-Centered Measurement

Abstract

Abstract Contemporary medicine is Janus-faced. Evidence-based medicine is one face of it, emphasizing evidence, statistics, and method. Patient-centered care is the other, prioritizing patient experiences, judgment, and values. Government agencies, policymakers, major insurers, and clinicians have sought ways to bring these faces together. This book is about one such approach, patient-centered measurement. Patient-centered measurement is the idea that patient perspectives on, for instance, physical functioning or quality of life, should play an evidentiary role in determining how effective a drug is taken to be, the degree to which a hospital provides good-quality care, or whether a particular intervention should be funded by an insurer. This idea may sound prosaic, but in fact it’s nothing short of revolutionary. Patient-centered measurement treats patient perspectives on par with more traditional metrics such as mortality, morbidity, and safety. It says that patient views matter—not as an afterthought and not only at the bedside, but in the nuts and bolts of creating our evidence base. What’s more, these measures are popular. They are part of Food and Drug Administration initiatives, the UK’s development of the National Health Service, and Denmark’s policy to improve patient care. Yet despite these policies, initiatives, and recommendations, patient-centered measures present a puzzle. And this puzzle has its source in the Janus-faced nature of medicine. How can measurement, which relies on standardization, represent patient perspectives, which, if not idiosyncratic are at least various and changeable? This book aims to solve that puzzle.