Patient-centered Healthcare System Research Articles

Integrative und personalisierte Gesundheitsversorgung - Forderungen für ein zeitgemäßes Gesundheitssystem

In medical and public debates, the concept "personalized" or "individualized" medicine (PM) is increasingly used for the orientation of medicine towards individual genetic, molecular and biological characteristics. However, this tunnel view neglects that the human "person" or "individual" encompasses more than just the molecular and biological side, and that patients increasingly call for a more holistic and more person-centred form of health care. Therefore the authors propose to extend the concept of PM in the framework of an integrative health-care concept, so that with respect to a modern and patient-centred health-care system not only the biological, but also the relevant psychological, mental, social, cultural, spiritual, and economic aspects of the human individual are accounted for in health care. The Faculty of Health of Witten/Herdecke University proposes the term "integrative and personalised health care" for such a holistic form of PM.

Challenges and opportunities in implementing pharmacogenomics testing in the clinics.

The field of pharmacogenomics aims to incorporate individual patient genomic information into treatment selection. This is a rapidly evolving field with significant clinical promise. Implementation into clinical practice has several challenges that must be overcome. Genomics-based information encompasses large databases and requires expert knowledge for interpretation. Existing research suggests there are already several areas where pharmacogenomics-based decision-making is ripe for adoption into clinical practice. Impediments exist that must be overcome prior to large-scale implementation of existing pharmacogenomics-based therapies. There are several institutions and corporations at the forefront of implementation that are leading the development; however, larger systems-based approaches will be necessary. This article will discuss some of the present successes and future challenges that are necessary to overcome in order to implement a more patient-centered healthcare system.

A Novel Approach to Identifying Targets for Cost Reduction in the Emergency Department

This article introduces a novel framework that classifies emergency department (ED) visits according to broad categories of severity, identifying those categories of visits that present the most potential for reducing costs associated with the ED. Although cost savings directly attributable to the ED are apt to be an important emphasis of organizations operating under reformed payment systems, our framework suggests that a focus on diverting low-acuity visits away from the ED would result in far less savings compared with strategies aimed at reducing admissions and to a lesser extent improving the efficiency of ED care for intermediate or complex conditions. We conclude that targeting these categories, rather than minor injuries/illnesses, should be the primary focus of cost-reduction strategies from the ED. Given this understanding, we then discuss the implications of these findings on the financing of an emergency care system that needs to account for the required fixed costs of "stand-by capacity" of the ED and explore ways in which the ED can be better integrated into a patient-centered health care system.

Supporting implementation of evidence-based behavioral interventions: the role of data liquidity in facilitating translational behavioral medicine.

The advancement of translational behavioral medicine will require that we discover new methods of managing large volumes of data from disparate sources such as disease surveillance systems, public health systems, and health information systems containing patient-centered data informed by behavioral and social sciences. The term "liquidity," when applied to data, refers to its availability and free flow throughout human/computer interactions. In seeking to achieve liquidity, the focus is not on creating a single, comprehensive database or set of coordinated datasets, nor is it solely on developing the electronic health record as the "one-stop shopping" source of health-related data. Rather, attention is on ensuring the availability of secure data through the various methods of collecting and storing data currently existent or under development-so that these components of the health information infrastructure together support a liquid data system. The value of accessible, interoperable, high-volume, reliable, secure, and contextually appropriate data is becoming apparent in many areas of the healthcare system, and health information liquidity is currently viewed as an important component of a patient-centered healthcare system. The translation from research interventions to behavioral and psychosocial indicators challenges the designers of healthcare systems to include this new set of data in the correct context. With the intention of advancing translational behavioral medicine at the local level, "on the ground" in the clinical office and research institution, this commentary discusses data liquidity from the patient's and clinician's perspective, requirements for a liquid healthcare data system, and the ways in which data liquidity can support translational behavioral medicine.

Integrating traditional medicine with biomedicine towards a patient-centered healthcare system

In this new age of scientific developments, biomedicine makes it possible for us to draw precise pictures of the internal workings of the human body, measure tiny metabolic reactions,exchange organs from one person to another,and even grow babies in test tubes.These accomplishments have enabled us to alter successfully and dramatically the natural history of many diseases.Nobody can detract from these achievements, and it is a matter of course for biomedicine to be regarded as conventional medicine or mainstream medicine.However,biomedicine is at its limits nowadays

If You Build It, Will They Come? Designing Truly Patient-Centered Health Care

As the United States debates how to reorganize its health care system, policy makers must ask what patients really want and need from their primary care providers. There is often a disconnect between what patients say they want and what other providers or payers think patients want. Our research at the National Partnership for Women and Families suggests that a truly patient-centered health care system must be designed to incorporate features that matter to patients--including "whole person" care, comprehensive communication and coordination, patient support and empowerment, and ready access. Without these features, and without consumer input into the design, ongoing practice, and evaluation of new models, patients may reject new approaches such as medical homes and accountable care organizations.

Secret Shoppers in Healthcare

Considerable resources are expended to change current practices and create patient-centered, evidence-based, and safer healthcare systems. Despite tireless efforts of administrators, significant differences still exist between the ideal and actual healthcare experience. Many patients feel the need to hire healthcare advocates to protect them from the dangers and discomforts of an inpatient experience. I ponder the lack of progress and speculate about the gaps. Considerable resources are expended to change current practices and create patient-centered, evidence-based, and safer healthcare systems. Despite tireless efforts of administrators, significant differences still exist between the ideal and actual healthcare experience. Many patients feel the need to hire healthcare advocates to protect them from the dangers and discomforts of an inpatient experience. I ponder the lack of progress and speculate about the gaps.

Sharing Decision Making About Cardiac Surgery

Aortic valve replacement surgery is the only available treatment option able to improve survival in patients with symptomatic and severe aortic valve stenosis. Without surgical intervention, patients with symptomatic dyspnea and severe aortic valve stenosis have a median survival less than 2 years. In an ideal, patient-centered healthcare system, the decision whether to undergo risky yet potentially life-prolonging surgery should not only reflect judicious application of the evidence of safety and efficacy of the surgery, but it also should be consistent with the patient’s clinical and personal contexts, and their goals, values, and preferences for life and healthcare. Article see p 533 The report by Bach et al1 is the latest in their series of investigations to uncover why cardiac valve replacement surgery is underused among eligible candidates. In this report, they seek explanations among patient, clinician, and hospital-level characteristics and suggest the following hypothesis: clinicians, particularly cardiologists, are making apparently inconsistent judgments as to which patients should be referred to cardiac surgeons for consideration of aortic valve replacement. Among 191 patients with severe aortic valve stenosis who did not undergo cardiac surgery, a cardiologist evaluated 182 (95%), but referred only 57 (30%) to a cardiac surgeon. In this editorial, we will place this finding in the context of the evolving field of shared decision-making and suggest how this focus could improve the quality of care delivered to patients with valvular heart disease. Shared decision making is a 3-step process.2 The first step involves knowledge transfer. In its idealized form, shared decision making requires symmetrical and bidirectional exchange of information between patients and clinicians. This exchange aims to identify and distinguish the available options under consideration, including the option of no treatment. The other 2 steps require the patient and clinician to (1) actively engage in deliberating (ie, …

Editorial: Managing chronic illness – challenges and opportunities for practice and research

Editorial: Managing chronic illness – challenges and opportunities for practice and research

Evolving Applications for Patient-Centered Health Status Measures

Patient-centered health status measures-assessments of patients' symptoms, function, and quality of life-have matured substantially over the past 2 decades. Currently, valid, reliable, and sensitive disease-specific measures are available for quantifying the health status of patients with cardiovascular disease. This article briefly reviews the concept of health status measures, with a focus on their interpretation. It then discusses both the rationale and potential applications of health status measures in clinical care. Health status measures are not surrogate measures of outcome but rather highly meaningful outcomes of care. As such, they have important emerging roles as outcomes in clinical trials, as tools for monitoring patients in routine clinical care, as a mechanism for operationalizing and evaluating disease management programs, and as tools for quality assessment/improvement. Over time, it is expected that health status measures will also have an increasingly important role in patient-centered medical decision making. By becoming aware of the evolving roles of health status measures, clinicians can help to accelerate the realization of the Institute of Medicine's vision for a more transparent, evidence-based, patient-centered healthcare system.

Management of complex chronic disease: facing the challenges in the Canadian health-care system

This paper discusses the challenges that those living with complex chronic disease present to the Canadian health-care system. The literature suggests home care and the management of complex chronic disease can together ease many of the present and future pressures facing the health-care system in dealing with this new health-care phenomenon. A review of current literature and dialogue with key informants reveals that the current level of investment and the present policy environment are not sustainable to support the health-care system. In this paper, changes to policy and resource allocation to the home care sector are suggested to help manage complex chronic disease and thus improve the effectiveness of the Canadian health-care system. A case is made for a reorganization and increased commitment to the home care sector for a more efficient and patient-centred health-care delivery system.

Measuring Primary Care Physician Visit Continuity and Patients’ Experiences of Visit Continuity

To the Editor:— Dr. Wasson asserts that patient-reported visit continuity measures are valuable because they provide important information about how patients interpret the continuity of care they receive. We agree that patient-reported information is important. And we absolutely did not intend to cause the “elimination of patient reports” as Dr. Wasson says he fears. Patient-reported care experience information is key to a balanced portfolio of quality measures and indispensable to the goal of getting to a patient-centered health care system. However, our analytic findings led us to caution against relying on patient reported continuity of care measures in isolation — given evidence that they capture a combination of information about continuity along with information about other dimensions of the patient’s experience. Administrative continuity measures have proven, in our study and others,1 to provide a purer, more valid view of that dimension of care. Our results indicate that widely-used patient-reported visit continuity measures do not substitute for administrative data,2 especially if the goal is to understand how visit continuity with primary care physicians (PCPs) affects quality and outcomes of care.

PATIENT PERCEPTIONS OF THE QUALITY OF HEALTH SERVICES

As calls are made for a more patient-centered health care system, it becomes critical to define and measure patient perceptions of health care quality and to understand more fully what drives those perceptions. This chapter identifies conceptual and methodological issues that make this task difficult, including the confusion between patient perceptions and patient satisfaction and the difficulty of determining whether systematic variations in patient perceptions should be attributed to differences in expectations or actual experiences. We propose a conceptual model to help unravel these knotty issues; review qualitative studies that report directly from patients on how they define quality; provide an overview of how health plans, hospitals, physicians, and health care in general are currently viewed by patients; assess whether and how patient health status and demographic characteristics relate to perceptions of health care quality; and identify where further, or more appropriately designed, research is needed. Our aim is to find out what patients want, need and experience in health care, not what professionals (however well-motivated) believe they need or get.

What Really Matters to Healthcare Consumers

Consumer satisfaction with healthcare is an important quality and outcome indicator. Satisfaction may be at the crux of survival for healthcare delivery systems because it creates the competitive edge in healthcare. To better understand patient satisfaction by examining consumer healthcare experiences and expectations, a study was conducted. An important concept identified in the data, MY CARE, refers to a constellation of quality healthcare features that were wished for by all participants and realized by only some of them. The features of MY CARE offer lessons for all healthcare leaders to use when making improvements in care delivery systems-improvements that could create a more patient-centered healthcare system and boost patient satisfaction.

First Patient-Centered Drug Information Service in Germany—A Descriptive Study

The majority of patients have unmet drug information needs, and patients' knowledge of their own treatment is often poor. This is a major obstacle to a more patient-centered healthcare system. To explore patterns of patients' unmet drug information needs and outcomes of counseling patients by a drug and therapy information center (DTIC). We established the first German DTIC for patients. In this descriptive study, data obtained on callers within 24 months were analyzed. Questionnaires for gathering information about callers' characteristics and the outcome of the advice were sent to all patients using the service after consultation. Data on all inquiries and evaluation sheets were documented and analyzed by a standardized database. During 24 months, 2049 telephone calls were recorded. Patients' unmet information needs were mainly related to adverse drug reactions/drug interactions (31.0%) and therapy information (27.2%). In 81.0% of the cases, patients' uncertainties regarding their prescribed medications were reduced, 37.9% discussed the advice with their physician, and 18.3% reported a reduction of physician visits as a result of our advice. The patient-physician relationship remained mainly (70.6%) unaffected after our intervention. The DTIC is useful as a source of medical expert advice. The service can help to reduce medication problems based on inadequate information and therefore avoid unnecessary healthcare utilization. With the knowledge provided, patients can participate in decisions affecting their own health. This procedure encourages greater confidence in the merits of drug therapy.

The history of advance directives. A literature review.

The Patient Self-Determination Act is one step needed to move to a more patient-centered health care system; nurses can aid in preserving patients' rights by helping older aduits develop advance directives.

Implementation of a patient-centred and physician-oriented healthcare information system.

Integration of information has enabled expeditious operation in air transfer, banking, shopping, and stock brokerage, but not in healthcare. Existing health information systems (HIS) are concerned too much with departmental performance and charge billing, and neglect the end users--the patients and the physicians. The resultant HIS then has divergent operation to antagonize the physicians, and has fragmented data to the disadvantage of patients. Recognizing the problems and the trend of HIS, this study proposed and implemented a patient-centred and physician-oriented HIS in a Urology clinic. The proposed HIS had patient care as its core, and accurately coded the patient's diagnoses and therapy information. It also offered a friendly environment and complete function for the physician to administrate medical records and to provide healthcare services. The HIS had client/server structure and an open system to protect the hardware investment and the software implementation. It will be the key to success in complete hospital environments.