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Summary Course GW4002MV Patient Centred Care Delivery
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Summary Course GW4002MV Patient Centred Care Delivery
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Summary Course GW4002MV Patient Centred Care DeliveryWorkgroup meeting Theme 1: Introduction to PCCD
Conceptually, patient centred care (PCC) encompasses providing care that is compassionate,
empathetic, and responsive to the needs, values, and expressed preferences of each
individual patient; patients should be informed decision makers in their care (IOM, 2001).
Care providers must have an understanding of the patient’s context. Most notably, a
“therapeutic alliance” must be established between care providers and patients.
Berwick (2009) suggested a new definition: “The experience (to the extent the individual
patient desires it) of transparency, individualization, recognition, respect, dignity, and choice
in all matters, without exception, related to one’s person, circumstances, and relationships in
health care”.
Patient-centered care implies individualized patient care based on patient specific
information rather than focusing exclusively on the disease. This creates a comprehensive
healthcare approach, where the physician tries to see the illness through the patient’s
perspective and is responsive to the patient’s needs and preferences. Patient-centered care
model is being increasingly recognized as important for the delivery of high-quality care.
Patient-centered care revolves around the issues of patient’s role in his or her own
healthcare. Patients have ethical values and legal mandate that allows them to make
informed decisions regarding their healthcare. Thus, physicians must facilitate the process of
informed decision making and tailor the treatment(s) to match patient preferences (or
needs).
The patient-centered care model in healthcare should integrate patient preferences, needs
and wants, engage patients in clinical decision making and tailor the treatment to maximize
outcomes in a cost effective way. Thus, patient-centered care model integrates
1. understanding the patient and the illness,
2. arriving at mutual understanding regarding illness management and therapeutic
alliance,
3. providing valued information,
4. enhancing hospital, doctor and patient relationship; and
5. sensitivity about resource allocation and cost.
The patient-centered care model that integrates mutually beneficial partnerships among
healthcare providers, patients and families has profound implications for the planning,
delivery, and evaluation of care. Patient-centered care and evidence based care are not
mutually exclusive. More importantly, at the core the patient-centered care is the quality of
interactions between patients and care providers. Thus, the value of information plays a
crucial role in patient centered and evidence based practices.
1. Explain the two conceptual models (both Rathert and Jayadevappa) and their
addition to the literature.
,The Rathert (Donabedian (1988)) model
This model holds that, “good structure increases the likelihood of good process, and good
process increases the likelihood of good outcome”. There are two elements of process:
- technical processes, which include appropriate diagnoses and strategies for care
based on knowledge, judgment, and skill in implementing the strategies
- interpersonal processes, which include exchange of information necessary for an
accurate diagnosis, and to determine preferences and acceptability for specific care
methods.
Technical care is implemented through interpersonal interactions. Thus, it is important to
learn what specific PCC processes are indeed related to better outcomes.
- Moderating variables indicate conditions under which an independent variable may
influence outcomes. Identifying moderators will lead to greater understanding of
how certain contexts or patient life circumstances may influence PCC and patients,
hence, will explain some variability in outcomes unrelated to processes.
- Mediating variables help explain how or why a relationship exists between an
independent variable and an outcome. Identification of mediators will lead to greater
understanding about the mechanisms through which PCC may operate to influence
outcomes.
Overall, the literature on PCC processes and outcomes portrays generally positive empirical
relationships between PCC and intermediate as well as some distal outcomes. Some
consistent variables that appear to play moderating (patient condition, expectations) or
mediating (patient activation, adherence) roles.
Rathert et al. (2013)
This model spells out the process from which you go from different PCC dimensions to an
,outcome. 8 variables that influence outcomes, there are central for PCC. Mediators and
moderators influence how much impact these variables have.
mediators explain the underlying mechanisms from process to outcomes, within
mediators we look at the ‘why’, why we see a certain outcome
moderators we talk about under which condition
Conceptual model Jayadevappa
The conceptual model of patient-centered care consists of multiple domains (e.g., patient
demographics and clinical characteristics, hospital, nurse and physician attributes) that
influence treatment choice, process of care and outcomes. Patientcentered care
encompasses informed decision making and is a particular process of decision making by
patient and physician where the patient:
1. understands the risk or seriousness of the disease or condition to be prevented;
2. understands the preventive service, including the risks, benefits, alternatives and
uncertainties;
3. has weighted his or her values regarding the potential benefits and harms associated
with treatment; and
4. has engaged in decision making at a level that he or she desires and feels
comfortable.
Patients differ, across age and ethnicity, in the extent to which they wish to be involved in
decision making for their medical care and treatment. Although some patients prefer to
actively participate in decision making, others opt for a more passive role and defer
decisions to their physicians. Physicians and nurses are thus encouraged to tailor the medical
care per the preferences of patients. Since patients’ decision about healthcare utilization
may be influenced by their tastes and preferences, it is important to have a better
understanding of these preferences. Respecting the patient’s needs and preferences and
improving the trust between patient and their caregiver is one of the key attributes of
patient-centered care.
, Jayadevappa & Chhatre (2011)
Gives more insight in how healthcare takes place and what influences the decisions you
make. Thinks about PCC but more from the perspective of the healthcare organisation (you
can see this because of the costs organisations have limited resources). With PCC you
also have to take into account the perspective of the provider. Provider characteristics are
important because of the care they are able to deliver. Patient characteristics are important
to ensure the right care for the right individual, for example take into account clinical
conditions (maybe a condition impairs certain interventions).
2. Explain the eight dimensions of PCC and give an example of care within each
dimension. Think of examples that were not mentioned in the video lecture.
Patients generally define PCC in terms of eight dimensions:
a) respect for patient preferences, values, and expressed needs; choice between types
of treatments.
b) information, education, and communication;
c) coordination and integration of care and services; referrals within same organisation
d) emotional support; referral to a psychologist
e) physical comfort; environment in which care takes place, quiet, cosiness
f) involvement of family and close others; discuss and describe conditions to make
them understand.
g) continuity and transition from hospital to home; referrals to other specialists
h) access to care and services; health insurance
3. In which situations are the PCC models of Jayadevappa and Chhatre and Rathert and
colleagues best applicable?
Rathert is more specific for the patient the process.
Javadevappa is more focused on the organisation itself (healthcare provider). Provider
characteristics, costs.
4. Can the two models be integrated? If so, what would that look like?
You can integrate the two models by placing the Process at PCC. Mediators and moderators
on the left side and at provider characteristics. …
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