Class notes
HCM Patient Centered Care Delivery (lectures/working groups)
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Summary of the lectures and working groups of the first course of the master healthcare management: patient centered care delivery.
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Patient Centered Care Delivery 2021 | Joyce RommensTheme 1 – Innovative approaches
Targets:
- Can analyze important theories and conceptual models concerning PCCD;
- Understand various models of PCC and know when to use them;
- Can explain the (lack of) effectiveness of PCC initiatives;
- Can apply important dimensions of PCC;
- Can analyze innovative programs that incorporate PCCD.
Lecture
Part A: What is patient-centered care?
PCCD movement is opposed the previous paternalistic view of care delivery. The institute of
medicine named patient-centered care delivery as one of the important quality domains in health
care.
Patients are leaders and drivers of their own care delivery. For example, by shared decision making.
According to the institute of medicine, PCC is respectful and responsive to a patients’ preferences,
their needs, and their values.
While 94% wants to participate, 48% of Dutch patients find it hard to take an active role in their care.
Professionals do not always attempt to involve patients in the decision-making process:
- Professionals do not always tend to present all treatment options to patients
- Sometimes patients are not aware that there is something to choose
- Options are not always present neutrally or equally
® Patients may experience that their involvement is not really wanted.
What distinguishes patient centered care is that it involves actions on the collaboration with patients
and not just on their behalf. It requires professionals to share power even if that feels uncomfortable
to them.
In Europe almost half of the population (47%) has trouble understanding healthcare information. This
is 1/3 of the Dutch population. Half of the professionals in a study were not aware that the patients
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, Patient Centered Care Delivery 2021 | Joyce Rommens
did not understand them correctly. Most patients simply listen, go home, and try to figure it out by
themselves. While at the same time, health care professionals believe that the patients did
understand them.
We are increasingly aware of the need for diversity in healthcare. There is not one type of care that is
best for all patient populations.
Patient centered care is hard; we know it works but are clueless to what it looks like. In the literature
you will read a systematic review on how organizations implement PCC. Those organizations report
better organization- and patient outcomes.
The first thing about patient centered care is being respectful and taking decisions together. The
professionals will also know you as a person.
Certain aspects are more relevant when it comes to PCC:
- Coordination of care
- The involvement of family and friends
- Not just considering physical health but also mental health and social needs of patients
Patients with multimorbidity are often excluded from clinical trials to research the effectiveness from
a treatment. It is therefore complex to evaluate those patient centered care interventions. The
effectiveness for interventions is not the same for all groups of patients.
In response to, for instance, the higher life expectancy of higher educated people, there is a
movement from authority-based care to evidence based medicine leading to context-based
medicine.
Part B: Eight dimensions of PCC
Model of the social production function theory:
Nowadays healthcare is more focused on the psychical aspects of well-being. There is a challenge to
invest in the social well-being as well.
“Healthcare that establishes a partnership among practitioners, patients, and their families (when
appropriate) to ensure that decisions respect patients’ wants, needs, and preferences and that
patients have the education and support they need to make decisions and participate in their own
care.”
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, Patient Centered Care Delivery 2021 | Joyce Rommens
The 8 dimensions of patient centered care:
1. Patient preferences
a. Professionals should treat patients with respect
b. The quality of life must be taken into consideration
c. Preferences can change over time, especially for patients whose health status
changes
2. Information and education
a. Clear and accessible information about the condition, treatment, and support they
can get
3. Access to care
a. Waiting times
b. Having multiple options for consultations
c. Accessible buildings (for people in wheelchairs)
d. Access to medications (being able to easily request a recipe from the GP)
4. Emotional support
a. The impact on the quality of life by a certain health condition
b. Worries and fears among patients
5. Family and friends
a. Involvement in decisions
b. Attention to the role and needs of informal caregivers
6. Coordination of care
a. Professionals should be well-informed so that patients don’t have to repeat their
story repeatedly
b. Having regular team meetings and a case manager
7. Physical comfort
a. Clinical aspects: pain should be managed, and attention should be paid to, for
example, sleep problems of patients
b. Organizational level: comfort during their visit to the healthcare organization
(hygiene, privacy)
8. Continuity and transition
a. Change from one care setting to another should be as seamless as possible
b. Transfer of all relevant patient information
Organizations really need to improve all the dimensions to become more patient centered. However,
the diversity of patients should be considered.
Views of patients with multimorbidity:
1. Prepared proactive patients
a. The focus should be on the patients’ physical health
2. Everyday patients
a. They seem to be less informed; they easily turn to health care professionals with
their questions
3. Vulnerable patients
a. Less resourceful in communication skills or finances
b. Shared decision making is therefore more challenging for this group of patients
c. They require professionals that take the lead in the care process
Part C: Conceptual model of PCC
Model by Rathert et al. (2012):
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, Patient Centered Care Delivery 2021 | Joyce Rommens
Organizing care according to the 8 dimensions of PCC is expected to result in improved
organizational- and patient outcomes. In this model they focus on the linkages between PCC
processes and outcomes. There may be other factors that play a moderating or mediating role
between PCC processes and outcomes.
A moderator is a third variable that affects the direction or strength of the relationship between an
independent and dependent variable.
A mediator explains the mechanism that underlies an observed relationship between an
independent variable and a dependent variable.
Evidence-bases and patient-centered care by Lacy & Backer (2008):
In the continuum model care can vary from completely evidence based to completely patient
centered. A balance between the two is argued to be the best practice. The cyclical model focuses on
going from one approach to the other and back.
Working Group
Rathert C, Wyrwich MD, Boren SA. (2013) & Jayadevappa R, Chhatre S. (2011)
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