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Case 5 The patient as a partner – IQMKnowledge translation: using current knowledge for guidelines and decision making.
1.What is personalization of care?
Personalization must not be mixed up with customization.
- Customization relates to changing, assembling, or modifying product or service components
according to customers’ needs and desires.
- Personalization involves intense communication and interaction between two parties,
namely customer and supplier.
Personalization in general is about selecting or filtering information objects for an individual by using
information about that individual (the customer profile) and then negotiating the selection with the
individual.
Industrialization of health care (Kongstvedt, 1997): a change that affected almost all aspects of
health care delivery, influencing how risks are allocated, how care is organized, and how
professionals are motivated and incentivized.
This industrialization process can be described utilizing the dynamic stability model of
Boynton, Victor, and Pine (1993), which presents various industrial transformation strategies
For example: one strategy follows the traditional route of industrialization utilizing mass production
to ensure high levels of process stability.
However: most health care activities have followed an alternate route that is also described by this
model, bypassing mass production due to the high variability in patient needs and using techniques
of CQI and process reengineering
Mass customization: is applied to a larger population - specific for a disease like diabetes.
Mass production: e.g. vaccines
The future has arrived in the form of what many authors call “mass personalization.” It represents
an even more intense involvement of customers in product and service delivery choices (SDM).
E.g. Disease management programs for specific subgroups (within a specific disease)
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, Crafts: payment systems
Development/Modularization: care pathways
Figure 1.5 suggests how this individualization of healthcare will occur in health care.
- As scientific information about a health care process accumulates, it shifts from the craft stage to
the process enhancement stage.
- After the process is codified and developed further, it may shift into the mass production mode if
the approach is sufficiently and the volume is high and the patients will accept this impersonal mode
of delivery.
- If there is still too much art or lack of science to justify codification, the enhanced process can be
returned to the craft mode or moved into the mass customization and co-configuration pathway
towards mass personalization (the scheme gets more specific when it moves to the right)
The growth in health care personalization goes beyond patients having access to medical
information; it relates directly to medical strategies and emerging science for providing higher
quality, safer, more personalized treatments.
This trend draws strength from a vision of personalized medicine primarily in terms of
genomic medicine; it is a means of “focusing on the best ways to develop new therapies and
optimize prescribing by steering patients to the right drug at the right dose at the right time”
(Hamburg & Collins).
This vision includes partnerships among industry, academia, doctors, patients, and the public
that will lead to a “national highway for personalized medicine.”
One of the earliest signs of success relates to identifying the optimal dosage and combination
of treatments for cancer patients
Personalized care: people have choice and control over the way their care is planned and delivered.
Personalized medicine: it is not about genomes only but also about, respect, autonomy and dignity
o Responsive to patient preferences, needs and values, ensuring that patient values guide all
clinical decisions
o Shared Decision Making is part of personalization of care
Patient-centred care:
o Multidimensional concept
o Difficult to grasp
o Difficult to measure (therefore easy to acknowledge when doctors think they provide good
care and overestimate their skills)
Patient participation ladder (Arnstein 1969):
-Informing -> Consulting -> Deciding together -> Acting together (self-medication) -> patient in
control (if doctor agrees with patient)
-So basically patients will get more to day and participate more compared to the past
How should we involve patients in guideline development? New style guidelines
o All stakeholders involved (patients as well)
o Declaration of interest (financial conflict)
o 2-3 patients coached network
o Short 10-15 recommendations
o All relevant evidence
o Patient information about guideline
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