Summary Patient Centered Care Delivery
HC 1 Patient Centered Care Delivery models
Patient centered care: “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”
PCC is introduced by WHO and is like a trend now,
every health organization is busy with PCC.
Before PCC was introduced the main focus of well-
being was the physical well-being. When patients
were in pain, they visit a healthcare professional
and they helped them out. When you want to
improve the overall well-being, the social well-
being is a big part. PCC is trying to improve both,
physical well-being and social well-being.
Outcomes of PCCD:
- Greater satisfaction with care
- Greater quality of life and well-being of patients
- Greater job satisfaction among healthcare professionals
- Increased quality and safety of care
How to organize PCCD: 8 domains (Picker
Institute)
All domains need at a certain level to
improve the PCC.
1. Patient preferences: patient is the
expert.
Ex - personal treatment plan
2. Information and education: patients
need to understand the information
Ex – Self management skills, flyers,
understandable leaflet
3. Access to care
Ex – Health insurance, wheelchair
friendly, environment, internet appointments, clear directions, foreign language
4. Emotional support: mental health
Ex – support group
5. Family and friends
Ex - RMD house, family can stay
6. Coordination of care: professionals work together within 1 institution
Ex – multidisciplinary teams, case manager, first point of contact
7. Physical comfort: setting of a hospital (soft chairs)
Ex - Chemo garden, pain management
8. Continuity and transition: Outside of the institution between Institutions.
Ex – EPD
FACCPIEP
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,Conceptual model PCC by Rathert
Tries to find a definition of PCC.
Process: 8 domains of PCC positively influence the outcome. It leads to a higher patient satisfaction.
Moderating variables: conditions under which
an independent variable may influence
outcomes. Identifying moderators will lead to
greater understanding of how certain
contexts or patients 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. Shared
decision making leads to higher patient
adherence and that leads to better outcomes.
These studies suggest that moderators and mediators may explain significant variance in patient outcomes.
Evidence-based Patient-centered care by Lacy & Backer
New trend: Evidence-based Patient centered care: combination of evidence-based medicine and patient
centered care. 4 models to combine:
- Either or model: separate and mutual exclusive
- Integrated model: evidence-based can’t be done
without patient preferences. Take place at the
same time.
- Continuum model: Balance from purely evidence
based to purely patient centered
- Cyclical model: A cycle from evidence to patient
centered, etc. Dynamic movement between the
two motes of operating.
Example: patient preference mixed with evidence-
based treatments. Patient preferences in context
of evidence. More a process.
Barriers of PCC
Time, money and patient characteristic
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, Literature week 1
1. Rathert: Patient-Centered Care and
Outcomes: A Systematic Review of the
Literature
This article tries to find a definition of PCC.
They also want to see how PCC is related to
certain outcomes.
This model formulates 8 dimensions to define
PCC. These are related to the 3 different
outcomes: patient satisfaction, patient clinical
outcomes and organizational outcomes.
1. Respect for patient preferences: Treatment options, making goals together
2. Information, education and communication Information about treatment, potential risks and
benefits, educate coping, lifestyle advices, talk in a way
patient understand
3. Coordination and integration Case manager, more than one practice involvement:
communication
4. Emotional support Anxiety, fear of disease or treatment
5. Physical comfort Privacy, comfortable waiting areas
6. Involvement of family Involve them, disease does not only affect the patient,
especially vulnerable people
7. Continuity and transition Aftercare, well taken care of after you leave
8. Access to care No long waiting list, access public transport
You could see these dimensions as some sort of provider characteristics that influence these outcome. So
for example if I feel like I got a lot of information and education about the treatment of COPD, I feel
satisfied with the care. And because I’ve been thought about quit smoking etc, this can have an impact on
clinical outcomes ass well. So these characteristics influence these aspects.
They include moderators and mediators. You could see these variables as some sort of patient
characteristics that potentially influence these outcomes. So these are the:
- Moderating variables explain the conditions under which independent variables will influence
outcomes.
- Mediating variables explain why such relationships exist.
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