Principles Of Patient-centered Care Research Articles

Understanding the Healthcare Needs of Living Kidney Donors Using the Picker Principles of Patient-centered Care: A Scoping Review.

Living kidney donors (LKDs) undertake a complex and multifaceted journey when pursuing donation and have several unmet healthcare needs. A comprehensive understanding of these needs across their entire donation trajectory can help develop a patient-centered care model. We conducted a scoping review to synthesize empirical evidence, published since 2000, on LKDs' experiences with healthcare from when they decided to pursue donation to postdonation care, and what they reported as their care needs. We categorized them according to the 8 Picker principles of patient-centered care. Of the 4514 articles screened, 47 were included. Ample literature highlighted the need for (1) holistic, adaptable, and linguistically appropriate approaches to education and information; (2) systematic, consistent, and proactive coordination and integration of care; and (3) self-management and preparation to optimize perioperative physical comfort. Some literature highlighted the need for (4) better continuity and transition of care postdonation. Two key unmet needs were the lack of (5) a holistic psychosocial evaluation predonation and predischarge to provide emotional support and alleviation of fear and anxiety; and (6) access to specialty and psychosocial services postdonation especially when adverse events occurred. Limited literature explored the principles of (7) respect for patients' values, preferences, and expressed needs; and (8) involvement of family and friends as caregivers. We summarize several unmet healthcare needs of LKDs throughout their donation journey and highlight knowledge gaps. Addressing them can improve their well-being and experiences, and potentially address inequities in living kidney donation and increase living donor kidney transplantation.

Scope of Practice: Shared Decision-Making For Patient-Centered Care

Shared decision-making (SDM) represents a collaborative model of healthcare decision-making, contrasting the traditional unidirectional approach where physicians solely determine medical choices. SDM engages patients in evaluating options based on individual goals and values. In various clinical scenarios, SDM proves indispensable, enhancing patient satisfaction, treatment adherence, and reducing the likelihood of blaming physicians for adverse outcomes. Illustrated by the BRAN questions in the UK, SDM serves as a tool to explore benefits, risks, alternatives, and the option of doing nothing. Notwithstanding its benefits, SDM encounters implementation challenges, including time constraints and varying patient priorities. Elderly patients may face cognitive barriers, exacerbated by limited clinical trials catering to diverse geriatric needs. Nevertheless, SDM offers significant advantages, fostering strong patient-physician relationships, aligning with patient-centered care principles, and yielding positive outcomes. Physicians must integrate SDM consciously into clinical practice, recognizing its potential to improve patient satisfaction, quality of life, and overall healthcare outcomes. Bangladesh J Medicine 2024; 35: 122-123

IMPLEMENTATION OF PATIENT-CENTERED MEDICAL CARE MODEL: ANALYSIS OF THE ATTITUDES OF PATIENTS WITH CORONARY ARTERY DISEASE AND COMORBIDITIES

The aim: to evaluate the attitude of patients with coronary artery disease and comorbidities to the implementation of patient-centered care in clinical practice.
 Materials and methods. We carried out questionnaire survey of two groups of patients with coronary artery disease and comorbidities. The first one consisted of 30 patients with coronary artery disease aged 61-75 (mean age 67,2±5,1 years) who were followed by the cardiologist in the therapeutic department of the State Institution of Sciences “Research and Practical Center of Preventive and Clinical Medicine” State Administrative Department. The second one – 33 military personnel with coronary artery disease aged 50-58 years (mean age 53,2±2,4 years) who came for a scheduled appointment with a general practitioner at the Outpatient Care Clinic of the National military medical clinical center “GVKG”. Methods: system analysis, questionnaire survey, statistical.
 Results. According to patient`s opinion cardiologists give much more information about pharmacological treatment, including side effects of medications used (83,3±6,8% in the Ist group vs 33,3±8,2% in the 2nd group, p<0,05) and actions to increase patients` compliance (83,3±6,8% in the Ist group vs 42,4± 8,6% in the 2nd group, p<0,05). This is related to the peculiarities of management of patients with chronic diseases in the State Institution of Science “Research and Practical Center of Preventive and Clinical Medicine” State Administrative Department, in particular, with the follow-up of high-risk cardiac patients, including scheduled appointments and monitoring of patient`s clinical conditions by a cardiologist. Emotional support was given to 93,3±4,6% of patients in the Ist group and to 18,2±6,7% of patients in the 2nd group (p<0,05). 36,7±8,8% of patients in the Ist group and 84,8±6,3% in the 2nd group ( p<0,05) indicated, that they need more information about their treatment plan and involvement in clinical decision-making. 93,3±4,6% of patients in the Ist group and 4,8±6,3 % in the 2nd group were ready to perform self-monitoring of their health conditions and participate in the decision-making process regarding their treatment.
 Conclusions. Our survey demonstrated, that the majority of interviewed patients with coronary artery disease and comorbidities are ready to use basic principles of patient-centered care. The necessity to improve patient`s information and education about clinical decision-making and physician`s practical skills in the field of implementation of patient-centered care was substantiated.

Trio Rounding: Perceptions of Acute Inpatient Rehabilitation Nurses and Physicians.

The purpose of this study was to explore the process, benefits, and challenges of patient-centered Trio rounding in acute inpatient rehabilitation from the perspectives of nurses and physicians. A descriptive qualitative design was used in this study. Focus group interviews (FGIs) involving 27 nurses and physicians were thematically analyzed using Dedoose. A descriptive survey of rounding practices was conducted. Five primary themes were identified: (1) interprofessional team collaboration; (2) patient safety and quality of care; (3) communication, education, and patient/family partnering; (4) synchronicity of workflow; and (5) participants' recommendation to develop rehabilitation Trio rounding standard process. Themes were consistent with Picker's patient-centered care principles. Findings from a survey on current rounding practice done prior to the FGI reinforced participants' discussion on challenges in conducting patient-centered Trio rounding. Trio rounding in acute inpatient rehabilitation is a complex process challenged by asynchronous workflow and patients' therapy schedules. Nurses and physicians reported benefits outweighed challenges for Trio rounding in acute rehabilitation. The study provided valuable recommendations to develop acute inpatient rehabilitation Trio rounding standard process.

AI-Powered Patient-Centered Care: A Call to Action for Innovation.

The influential report Crossing the Quality Chasm: A New Health System for the 21st Century established six core objectives to enhance healthcare quality. It highlighted the necessity for healthcare to encompass safety, effectiveness, a patient-centered approach, timeliness, efficiency, and equity. This essay focuses on one of these six core objectives: a patient-centered approach. Healthcare leaders actively seek solutions to improve and ensure the delivery of high-quality care. The imperative to provide quality healthcare underscores the need for artificial intelligence (AI) to become an essential component in a patient-centered approach rather than merely an optional advantage. Despite the expansion of AI, there is a lack of understanding of how AI can improve patient-centered care. This essay examines the fundamental aspects of patient-centered care, as outlined by the Picker Institute, while also exploring the prospective role of AI in advancing the core principles of patient-centered care and proposing frameworks for applying AI in healthcare.

AI-Powered Patient-Centered Care: A Call to Action for Innovation.

The influential report Crossing the Quality Chasm: A New Health System for the 21st Century established six core objectives to enhance healthcare quality. It highlighted the necessity for healthcare to encompass safety, effectiveness, a patient-centered approach, timeliness, efficiency, and equity. This essay focuses on one of these six core objectives: a patient-centered approach. Healthcare leaders actively seek solutions to improve and ensure the delivery of high-quality care. The imperative to provide quality healthcare underscores the need for artificial intelligence (AI) to become an essential component in a patient-centered approach rather than merely an optional advantage. Despite the expansion of AI, there is a lack of understanding of how AI can improve patient-centered care. This essay examines the fundamental aspects of patient-centered care, as outlined by the Picker Institute, while also exploring the prospective role of AI in advancing the core principles of patient-centered care and proposing frameworks for applying AI in healthcare.

Woman-Centered Care: Standardized Outcomes Measure.

Background and Objectives: Patient- or woman-centered care, prioritizing women's perspectives, needs, and preferences, is a widely recommended approach to enhance the quality of maternity care services. It aligns with the broader principles of patient-centered care, emphasizing the importance of a collaborative and respectful relationship between healthcare providers and women. This study evaluates low-risk pregnancies managed by midwives and obstetrician-gynecologists in Lithuania using patient-reported outcome measures and patient-reported experience measures. Materials and Methods: A prospective cohort study was conducted between September 2022 and April 2023. Data were collected through patient-reported questionnaires. Results: A total of 153 pregnant women who had singleton, low-risk pregnancies participated in the study, of whom 24.8% had their pregnancies supervised by a midwife, and 75.2% of the participants had their pregnancies supervised by an obstetrician-gynecologist. The study found no statistically significant differences in assessed patient-reported outcome measures and patient-reported experience measures between both models of care. Conclusions: Adopting patient-centered approaches enables healthcare systems to understand and address women's specific needs and preferences, fostering high-quality and woman-centered care. This research adds to the growing evidence supporting midwife-led care and emphasizes the importance of personalized, woman-centered approaches in maternity care, ultimately enhancing maternal health outcomes and promoting positive experiences for low-risk pregnant women. The quality of care provided by midwives remains uncompromised and equivalently proficient compared to the care provided by collaborative teams.

Provider perspectives on patient-centredness: participatory formative research and rapid analysis methods to inform the design and implementation of a facility-based HIV care improvement intervention in Zambia.

Implementation of patient-centred care (PCC) practices in HIV treatment depends on healthcare workers' (HCWs) perceptions of the acceptability, appropriateness and feasibility of such practices (e.g. use of intentional, metric-driven activities to improve patient experiences). We applied rapid, rigorous formative research methods to refine a PCC intervention for future trial. In 2018, we conducted focus group discussions (FGDs) with 46 HCWs purposefully selected from two pilot sites. We elicited HCW perceptions of HIV service delivery, HCW motivation and perceived value of patient experience measures intended to improve PCC. FGDs utilized participatory methods to understand HCW responses to patient-reported care engagement challenges and Scholl's PCC Framework principles (e.g. seeing a patient as a unique person), enablers (e.g. care coordination) and activities (e.g. patient involvement). Our rapid analysis used analytic memos, thematic analysis, research team debriefs and HCW feedback to inform time-sensitive trial implementation. While HCWs nearly universally identified with and supported principles of PCC in both facilities, they raised practical barriers given the practice environment. HCWs described motivation to help patients, attached value to seeing positive health outcomes and the importance of teamwork. However, HCWs reported challenges with enablers needed to deliver PCC. HCWs cited a work culture characterized by differential power dynamics between cadres and departments restricting HCW autonomy and resource access. Barriers included inflexibility in accommodating individual patient needs due to high patient volumes, limited human resources, laboratory capacity, infrastructure and skills translating patient perspectives into practice. HCW motivation was negatively influenced by encounters with "difficult patients," and feeling "unappreciated" by management, resulting in cognitive dissonance between HCW beliefs and behaviours. However, the enactment of PCC values also occurred. Results suggested that PCC interventions should reduce practice barriers, highlighting the value of mentors who could help HCWs dynamically engage with health system constraints, to facilitate PCC. While HCWs perceived PCC principles as acceptable, they did not think it universally appropriate or feasible given the practice environment. Participatory and rapid methods provided timely insight that PCC interventions must provide clear and effective systems enabling PCC activities by measuring and mitigating relational and organizational constraints amenable to change such as inter-cadre coordination.

A Study of Microaggression and its Psychological and Physiological Effects on Individuals from Marginalised Communities

The psychological and physiological well-being of people is affected by an extensive range of circumstances. Although a single microaggression might appear innocuous, a lifetime of them can have a serious negative impact on someone's mental health. The research on microaggression and its psychological and physical impacts on people from marginalized communities in healthcare is reported in this publication. Two villages on AI reservations are involved in this community-based participatory study initiative. 130 adults participated in written surveys and interviews to gather data. More than one-third of the sample said they have come across a microaggression while interacting with their medical professionals. The self-reported histories of heart attacks, worse depressed symptoms, drug abuse, suicide cases, and preceding year hospitalization were all associated with complaints of microaggressions. In multivariate models, the connection between microaggressions and hospitalization (but just not a previous heart attack) seemed to be partially explained by assessments of depressive and drug abuse symptoms. In this research, microaggressions were linked to worse emotional and physiological health evaluations for Pakistani people living with a disease, undermining the principles of patient-centered care. Clinicians need to be aware of these subtly discriminatory behaviors, which are frequently unintentional.

The Lausanne Hospitality Model: a model integrating hospitality into supportive care

PurposeCancer care is undergoing a conceptual shift with the introduction of the principles of patient-centered care to support patients’ individual needs. These needs include those related to hospitality during cancer treatments. This paper aims to provide an extension of the supportive care framework by bringing in the hospitality approach inspired by the hotel industry.MethodThe “Lausanne Hospitality Model,” integrating hospitality into supportive care, was developed through an iterative process, combining expertise in supportive care and health services research, communication, and the hotel industry.ResultsThis conceptual paper integrates hospitality and service sciences into the supportive care framework. The “Lausanne Hospitality Model” offers new insights into the notions of cancer journey, patient experience, services, and practices that may be involved when facilitating hospitality. While most concepts used in the model are based on prior research, they have not been combined previously. The model highlights the place of hospitality in the patient’s experience within cancer services and, by extension, its role in professional practice.ConclusionPractices involved in the delivery of cancer care need to reinforce the importance attributed to hospitality services, as they impact patients’ experiences. By integrating the hospitality perspective into healthcare delivery and supportive care, this paper addresses previously theoretically overlooked aspects that impact patients’ experiences during cancer care.

The Integration of Patient-Centered Care and the Biopsychosocial Model by Athletic Trainers in the Secondary School Setting.

Our purpose was to explore the degree to which secondary school athletic trainers (SSATs) perceive they are integrating the principles of patient-centered care (PCC) and the biopsychosocial (BPS) model in their practice. We used a cross-sectional design to explore the primary research question. We used the Global Perceptions of Athletic Trainer Patient-Centered Care (GPATPCC) tool and the Biopsychosocial Model of Health (BPSMH) tool, both measured on a 4-point Likert scale (1 = strongly disagree, 2 = disagree, 3 = agree, 4 = strongly agree, with an unscored "unsure" option). We sent the survey to 5665 SSATs through the National Athletic Trainers' Association. Results indicate participants expressed strong agreement (mode = 4) with 7 of the 14 statements and agreement (mode = 3) with the remaining 7 statements of the GPATPCC tool (grand mean = 3.4 ± 0.8). Overall, participants rated their level of agreement on the BPSMH as agreeing (mode = 3) for each item (grand mean = 3.0 ± 1.0). SSATs perceive they are integrating the principles of PCC and the BPS model in clinical practice. These findings align with two previous studies concluding that patients, parents, and providers believe athletic trainers provide care that is focused on whole-person healthcare.

IMPLEMENTATION OF PATIENT-CENTERED CARE AND MEDICAL CARE IMPROVEMENT: CURRENT STATE (review)

The aim of the research: to conduct an analysis and generalization of scientific publications on the issue of the patient-centered care implementation in clinical practice setting.
 Results. The concept of a patient-centered care, proposed in the USA in the early 1990s, was subsequently used by the WHO in the development of the program for the development of the health care system in the 21st century. This approach shifts the focus from the traditional biomedical model, in which the doctor is given a priority role in decision-making to a model that establishes a partnership among practitioners, patients, and their families. Recent scientific publications identified eight principles of patient-centered care: respect for patient's values, preferences, and expressed needs, provision of information and education, emotional support to relieve fear and anxiety, involvement of family and friends, physical comfort and symptom`s relief, continuity and secure transition between healthcare settings, coordination of care, access to care. The implementation of a patient-centered care in clinical practice faces a number of difficulties, in particular, with regard to the influence of social, economic, financial factors, training of medical personnel and patient education. Another aspect is the heterogeneity of patients in terms of their ability to take a partnership approach and be involved in the decision-making process. Further clinical trials are needed to provide evidence for the practical use of the most effective approaches to patient-centered care implementation.
 Conclusions: The patient-centered care has become a key element of the quality of medical care and assumes that the care provided should meet the individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions. The introduction of a patient-centered care requires appropriate medical education of doctors to improve communication skills and patient`s education for involve patients in the treatment process as partners.

Patient-centered care in the Middle East and North African region: a systematic literature review

BackgroundThe need for patient centered care (PCC) and its subsequent implementation has gained policy maker attention worldwide. Despite the evidence showing the benefits and the challenges associated with practicing PCC in western countries there has been no comprehensive review of the literature on PCC practice in the Middle East and North African (MENA) region, yet there is good reason to think that the practices of PCC in these regions would be different.ObjectivesThis paper summarizes the existing research on the practice of PCC in the MENA region and uses this analysis to consider the key elements of a PCC definition based on MENA cultural contexts.MethodsFive electronic databases were searched (EMBASE, Cochrane, Medline, CINAHL and Scopus) using the search terms: patient OR person OR client OR consumer AND centered OR centred AND care. The MENA countries included were Bahrain, Iran, Iraq, Jordan, Kuwait, Lebanon, Oman, Palestine, Israel, Qatar, Saudi Arabia, Syria, United Arab Emirates, Yemen, Algeria, Egypt, Libya, Morocco, Tunisia, Djibouti, Pakistan, Sudan, and Turkey. Identified papers were imported to Covidence where they were independently reviewed against the inclusion criteria by two authors. The following data were extracted for each paper: author, year, location (i.e., country), objectives, methodology, study population, and results as they related to patient centred care.ResultThe electronic search identified 3582 potentially relevant studies. Fifty articles met the inclusion criteria. Across all papers five themes were identified: 1) patient centered care principles; 2) patient and physician perceptions of PCC; 3) facilitators of PCC; 4) implementation and impact of PCC; and 5) barriers to PCC.ConclusionThe preliminary findings suggest that the concept of PCC is practiced and supported to a limited extent in the MENA region, and that the implementation of PCC might be impacted by the cultural contexts of the region. Our review therefore highlights the importance of establishing patient-centered care definitions that clearly incorporate cultural practices in the MENA region. The elements and impact of culture in the MENA region should be investigated in future research.

Impact of the COVID-19 pandemic on patient perceptions of the quality of their cancer care.

286 Background: COVID has had a significant impact on how cancer care is delivered. Numerous modifications to care aimed at reducing in-person visits, and mitigating potential issues with staff and resource shortages were introduced, including the implementation of virtual visits. As many of the changes to cancer care are likely to persist beyond the pandemic, we undertook a survey to understand patients’ perceptions of the impact of the pandemic on the quality of cancer care that they received. Methods: We developed an electronic survey guided by the Picker Institute’s eight principles of patient-centred care. Patients >18 years of age with a valid email address on file who have had a visit in the gastrointestinal clinic at Princess Margaret Cancer Centre (PM) in Toronto, Canada between 03/2020 and 05/2021 were recruited via email invitation in 10/2021 to anonymously participate. Logistic regression models were utilized to examine adjusted associations between demographic and clinical variables, and reporting a negative perception of care. Results: The response rate was 17.1% (438/2563); after excluding responses from those who are no longer patients and incomplete responses, 358 responses were included in the final analysis. Respondents were most commonly >65 years of age (46.6%), male (48.6%), college/university educated (55.5%) and in follow-up phase of their disease (54.2%). Approximately half of respondents (56.1%) had some experience with care at PM prior to the pandemic, while the remaining patients were referred during. Most respondents (76.3%) indicated that, overall, they were satisfied with the care they received during COVID. Compared to patients who experienced care at PM prior to the pandemic, patients referred during COVID were 2.5 times more likely to believe that patients received worse care during COVID than those treated prior (OR: 2.42; 95% CI: 1.08-5.44). Most respondents (69.5%) reported that virtual appointments positively impacted the quality of their cancer care. Adequacy of emotional support was the most negatively perceived dimension of patient-centred care, whereby 18.7% of patients felt they were provided with inadequate information on support services available to them, and 17.6% felt that they had received inadequate support. Relative to those in follow-up, patients with a newly diagnosed cancer were more likely to report receipt of inadequate emotional support (OR: 5.69; 95% CI: 2.18-14.82). Conclusions: Most patients reported being satisfied with the quality of care provided to them during COVID and reported a positive impact of virtual appointments on their care. Future quality improvement efforts should focus on how to improve dissemination of information on available support services and access to appropriate emotional supports, particularly for newly diagnosed patients.

Impact of prolonged isolation on adolescents with drug-susceptible tuberculosis in Lima, Peru: a qualitative study

ObjectivesPatients with tuberculosis (TB) generally are instructed to isolate at the beginning of treatment in order to prevent disease transmission. The duration of isolation varies and may be prolonged (ie,...

Basis-Anforderungen einer Fachabteilung für Herzchirurgie.

The evolution and progress in cardiovascular medicine and substantial changes in the German health care system require both a reflection of the principles of patient-centered care in general and an update of the criteria that define a department of cardiac surgery in Germany. This position paper lists the core requirements for a cardiac surgical department with regard to infrastructure, facilities, necessary staff, and standard of care (processes). This standard may be used by hospitals and health care providers to ensure the safety and quality of cardiac surgical departments in Germany.

ShareHeart: A patient journey map of patients with ischemia and non-obstructive coronary artery disease based on qualitative research.

To visualise the health care experiences and needs of patients with ischemia with non-obstructive coronary arteries in a patient journey map. As such, future design challenges can be provided, and it can be used for future healthcare optimization. Ischemia with non-obstructive coronary arteries is a chronic cardiac condition caused by vascular dysfunctions. Ischemia with non-obstructive coronary arteries is often unrecognised, significantly impairs daily functioning, and is more prevalent among women. Patients' experiences remain unexplored, and a clear patient-centered care pathway is lacking. A qualitative interpretative research design was performed and the standards for reporting qualitative research (SRQR) has been used. In total, 36 women were included and participated in eight semi-structured focus group interviews. Thematic analysis was used, and identified themes were further classified using 'patient journey mapping.' Additionally, Picker's 'eight principles of patient-centered care' were linked to the results and integrated in the patient journey map. Participants experienced a lack of familiarity with the specific cardiac condition by healthcare providers, repeated hospitalisation, testing and referrals, shortage of specialised cardiologists, and feelings of not being heard. In addition, needs for a multidisciplinary treatment program (including physical and psychological support), better information provision, and an easily accessible contact person were expressed. The resulting patient journey map shows how patients experienced and interacted with the current healthcare system. Overall, the results show a complex and long healthcare pathway and important themes for healthcare experiences and needs were identified. Future research could focus on the development and implementation of a patient-centered evidence-based clinical pathway optimising experiences and quality of life. The visual tool can help health care professionals, policy makers, and researchers improve healthcare provision which is patient-centered and tailored to the preferences of patients with ischemia with non-obstructive coronary arteries.

Usability Testing of a Patient-Centered Mobile Health App for Supporting and Guiding the Pediatric Emergency Department Patient Journey: Mixed Methods Study.

BackgroundPatient experience in emergency departments (EDs) remains often suboptimal and can be a source of stress, particularly in pediatric settings. In an attempt to support patients and their families before, during, and after their visit to a pediatric ED, a mobile health (mHealth) app was developed by a multidisciplinary team based on patient-centered care principles.ObjectiveThis study aims to evaluate the usability (effectiveness, efficiency, and satisfaction) of a new mHealth app, InfoKids, by potential end users through usability testing.MethodsThe app was assessed through an in-laboratory, video-recorded evaluation in which participants had to execute 9 goal-oriented tasks, ranging from account creation to the reception of a diagnostic sheet at the end of the emergency care episode. Effectiveness was measured based on the task completion rate, efficiency on time on task, and user satisfaction according to answers to the System Usability Scale questionnaire. Think-aloud usability sessions were also transcribed and analyzed. Usability problems were rated for their severity and categorized according to ergonomic criteria.ResultsA total of 17 parents participated in the study. The overall completion rate was 97.4% (149/153). Overall, they reported good effectiveness, with the task successfully completed in 88.2% (135/153) of cases (95% CI 83%-93%). Each task, with the exception of the first, created difficulties for some participants but did not prevent their completion by most participants. Users reported an overall good to excellent perceived usability of the app. However, ergonomic evaluation identified 14 usability problems occurring 81 time. Among these, 50% (7/14) were serious as their severity was rated as either major or catastrophic and indicated areas of improvements for the app. Following the suggested usability improvements by participants, mitigation measures were listed to further improve the app and avoid barriers to its adoption.ConclusionsUsability of the InfoKids app was evaluated as good to excellent by users. Areas of improvement were identified, and mitigation measures were proposed to inform its development toward a universal app for all ED patients visiting a digitalized institution. Its contribution could also be useful in paving the way for further research on mobile apps aimed at supporting and accompanying patients in their care episodes, as research in this area is scarce.

Patient Vs. Soldier-Centered Medical Home: Comparing Access, Continuity, and Communication in the U.S. Army.

Over the last 40 years, patient-centered medical home (PCMH) has evolved as the leading primary care practice model, replacing traditional primary care models in the United States and internationally. The goal of PCMH is to improve chronic condition management. In the U.S. Army, the scope of the medical home, which encompasses various care delivery platforms, including PCMH and soldier-centered medical home (SCMH), extends beyond the management of chronic illnesses. These medical home platforms are designed to support the unique health care needs of the U.S. Army's most vital asset-the soldier. The PCMHs and SCMHs within the U.S. Army employ patient-centered care principles while incorporating nationally recognized structural attributes and care processes that work together in a complex adaptive system to improve organizational and patient outcomes. However, U.S. Army policies dictate differences in the structures of PCMHs and SCMHs. Researchers suggest that differences in medical home structures can impact how organizations operationalize care processes, leading to unwanted variance in organizational and patient outcomes. This study aimed to compare 3 care processes (access to care, primary care manager continuity, and patient-centered communication) between PCMHs and SCMHs. This was a retrospective, cross-sectional, and correlational study. We used a subset of data from the Military Data Repository collected between January 1, 2018, and December 31, 2018. The sample included 266 medical home teams providing care for active duty soldiers. Only active duty soldiers were included in the sample. We reviewed current U.S. Army Medical Department policies to describe the structures and operational functioning of PCMHs and SCMHs. General linear mixed regressions were used to evaluate the associations between medical home type and outcome measures. The U.S. Army Medical Department Center and School Institutional Review Board approved this study. There was no significant difference in access to 24-hour and future appointments or soldiers' perception of access between PCMHs and SCMHs. There was no significant difference in primary care manager continuity. There was a significant difference in medical home team continuity (P < .001), with SCMHs performing better. There was no significant difference in patient-centered communication scores. Our analysis showed that while the PCMH and SCMH models were designed to improve primary care manager continuity, access to care, and communication, medical home teams within the U.S. Army are not consistently meeting the Military Health System standard of care benchmarks for these care processes. Our findings comparing 3 critical medical home care processes suggest that structural differences may impact continuity but not access to care or communication. There is an opportunity to further explore and improve access to appointments within 24 hours, primary care manager and medical home team continuity, perception of access to care, and the quality of patient-centered communication among soldiers. Knowledge gained from this study is essential to soldier medical readiness.

Parental Perceptions of the Importance and Effectiveness of Patient-Centered Care Delivery

Integrative patient-centered care (PCC) models encompass all dimensions of the patient, including physical well-being, evidence-based shared decision making, and determinants of health as they relate to quality of life. The purpose of this study was to explore parental experiences with the principles of PCC, related to the healthcare of their dependent after interactions with a provider. Using an observational design, our results demonstrated that parents of adolescent athletes rated PCC concepts as “very important” and the care delivered in relation to PCC by providers as “very effective.” PCC is perceived as valuable to parents, and therefore, athletic trainers must continue to develop and integrate PCC in the delivery of care within their clinical practice.