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HCM Patient Centered Care Delivery (literature summary)
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Literature summary of the mandatory literature of the course: patient centered care delivery. Master Healthcare Management.
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Literature PCCD | Joyce RommensLiterature Theme 1 – Innovative approaches
1.1 Rathert et al. (2012) – Patient-centered care and outcomes: a systematic review
of the literature (25p)
Aim: to examine the PCC literature with attention how PCC has been operationalized, and how it has
been empirically associated with outcomes.
Eight dimensions (defined PCC by patients):
1. Respect for patient preferences, values, expressed needs.
2. Information, education, and communication.
3. Coordination and integration of care and services.
4. Emotional support.
5. Physical comfort.
6. Involvement of family and close others.
7. Continuity and transition from hospital to home.
8. Access to care and services.
Moderating vs. mediating variables:
− Moderating variables indicate conditions under which an independent variable may influence
outcomes.
− Mediating variables help explain how or why a relationship exists between an independent
variable and an outcome.
Two elements of process:
1. Technical processes: includes appropriate diagnosis and strategies for care based on
knowledge, judgement, and skills in implementing the strategy.
2. Interpersonal processes: include exchange of information necessary for an accurate
diagnosis, and to determine preferences and acceptability for specific care methods.
1.2 Jayadevappa & Chhatre (2011) – Patient centered care – a conceptual model
and review of the state of the art (8p)
Patient centered care (PCC):
− Improved communication,
− Appropriate intervention,
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, Literature PCCD | Joyce Rommens
− Enhanced satisfaction,
− Patient reported outcomes,
− Biomedical outcomes.
PCC implies individualized patient care based on patient-specific information. Implementation of PCC
led to a decrease in the average length of stay, improved patient satisfaction and efficient and
effective treatments, leading to lower costs of care.
Effectively operationalize PCC:
− Through education,
− Shared knowledge,
− Integrated and team management,
− Free flow and accessibility of valued information.
Dimensions of PCC:
1. Respecting patient’s individuality.
2. Coordination of care that is unique to the environment of hospitals and healthcare facilities.
3. Communication between patients and providers (physicians and nurses).
4. Intervention strategies for improving quality of PCC within an institution.
5. Minimizing physical trauma during acute care.
6. Supporting patient’s social and emotional needs, role of families, and continuity of care.
Cultural competences set out to make healthcare equitable for all, whereas PCC sets out to elevate
healthcare quality.
Both:
− Understand and are interested in the patient as a unique person.
− Use a bio-psychosocial model.
− Explore and respect patient’s beliefs, values, meaning of illness, preferences and needs.
− Build rapport and trust.
− Find common ground.
− Maintain and can convey unconditional positive regard.
− Are aware of their own biases/assumptions.
− Allow the involvement of friends/family when desired.
− Provide information and education tailored to patient’s level of understanding.
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, Literature PCCD | Joyce Rommens
1.3 Lacy & Backer (2008) – Evidence-based and patient-centered care results from
an STFM group project (5p)
The conscientious, explicit and judicious use of current best evidence in making decisions about the
care of patients.
PCC: The interweaving of six components:
1. Exploration of “both the disease and the illness experience
2. Understanding the whole person,
3. Finding common ground,
4. Incorporating prevention and health promotion,
5. Enhancing the patient-doctor relationship,
6. Being realistic.
Conceptual models
1. Integrated (EBPCC = a combination of EBM + PCC):
Group members conceptualized overlapping areas, creating a band of practices in which the
practitioner applies concept from both spheres.
2. Either/or (EBM / PCC):
each approach was distinct from the other.
3. Continuum (or Balance = EBM - PCC):
EBPCC ranged from purely EB to purely PC. This model suggests a point at which a clinician
incorporates both patient centeredness and EBM and that the best practice involved
balancing the two.
4. Cyclical (PCC > EBM > PCC > EBM etc.):
Describes a process of active movement between the two modes of operating. It’s a process
that moves from PCC and then back to EBM and back to PCC.
Principal barriers to EBPCC:
− Time restraints,
− Relational challenges,
− Finding common ground.
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, Literature PCCD | Joyce Rommens
1.4 Schwenk (2014) – The patient-centered medical home: one size does not fit all
(2p)
The patient-centered medical home (PCMH):
− Enhanced access for routine primary care,
− Improved delivery of preventive services,
− High-quality chronic disease management,
− Reduced emergency department and hospital utilization.
The identification of target populations shouldn’t be defined by disease, but by the simple measures
of utilization and cost.
High-risk and high-utilization patients would likely benefit from:
− Detailed health risk assessments,
− Integrated and intense comorbid disease management programs
− Assigned healthcare teams with:
¨ Multiple approaches to outreach and monitoring,
¨ Special post-hospital care protocols,
¨ Enhanced access and tracking of emergency department care.
1.5 Friedberg et al. (2014) – Association between participation in a multiplayer
medical home intervention and changes in quality, utilization, and costs of care (6p)
Aim: to measure association between participation in one of the largest and earliest multiplayer
medical home pilots, and changes in the quality, utilization, and costs of care.
Recent evidence reviews suggest that early “medical home” interventions have yielded modest
improvements at best in quality and patient experience, with little evidence of effects on costs of
care.
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