Workgroup one (03-09-2020)
Questions about:
Rathert C., Wyrwich MD., Boren SA. (2013). Patient-Centered Care and Outcomes: A Systematic Review of the
Literature. Med Care Res Rev. 70(4):351-79
Jayadevappa R., Chhatre., S. (2011). Patient Centered Care - A Conceptual Model and Review of the State of the
Art. The Open Health Services and Policy Journal, 4, 15-25.
1. Explain the two conceptual models (both Rathert and Jayadevappa) and their addition to
the literature
The first model is the one from Rathert:
They added moderators and mediators to it, compared to older literature.
According to this framework there are 2 elements of process:
- A technical process
Which include appropriate diagnoses and strategies for care based on knowledge, judgment,
and skill in implementing the strategies
- An 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; therefore, the success of
technical care depends on interpersonal processes
This model also focuses on long-term outcome, not only short-termed outcomes.
The models talks about the 8 different dimension of patient-centred care which have an effect on the
patient clinical outcomes, but also the patient satisfaction and organizational outcomes. These
dimension also have an effect on, for example, the degree of energy/action from the patient. Using
dimension of PCC may motivate the patient to take actions which will improve their clinical
outcomes. This is called the mediator in the model. The model also talks about the moderators,
which are the condition of the patient and the expectations of the patient. Some patients have a high
level of desire to participate in the care they are getting in comparison to some patients who don’t.
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, The degree of desire has an effect on the relationship between the PCC dimensions and the clinical
outcomes. This is the same for the moderator ‘patient type’, for example cancer patients who might
need more emotional support in comparison to other patients.
The second model is from Jayadevappa:
This model shows that PCC has multiple domains. The patient characteristics have an effect on the
different ways of PCC. PCC has to fit all these different preferences. The article showed that good PCC
may lead to less costs, which explains the arrow from PCC to costs in the model. PCC also has a
positive effect on outcomes, like quality of life, patient satisfaction, etc. The last aspect which
influences the PCC are the provider characteristics. There are lots of different hospitals, physicians
and nurses and the PCC has to be formed in all these different settings, it has to fit into the different
setting ánd the different patient preferences.
The provider characteristics (knowledge and the skills providers have), this has a influence on the
treatment choice. You try to minimize the costs but maximize the outcomes.
If the hospital has good facilities and the provider characteristics are good, like good communication,
the patient can chose a treatment which suits their preferences and this will minimize their costs.
Unsatisfied patients will often have a second opinion, so it’s cheaper to have satisfaction. Above all if
they are satisfied their outcome will be better, they will take their medicine etc. and it will also
influence the survival.
Do the costs also influence the treatment choice? It can be, when for example a treatment is
very expensive and it isn’t covered by the insurance, then it will influence the choice but the
costs in this model are meant as PCC minimizing costs.
Clinical convenience: these are the processes of care, so the providers have some characters but then
they also have to communicate to patients, they have to talk to their colleagues. So this part are
different processes which influence the treatment choice.
Clinical characterises: characteristics of the patients kind of decide what you treat on, so if you have
a patient who is very ill you chose a different option. So this means how the health of the patient is.
StudeerSnel
Eight core components of PCC
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