Summary of the course patient centered care delivery based on literature and lectures + summaries of all literature (listed below):
Rathert et al. (2013). Patient-Centered Care and Outcomes: A Systematic Review of the Literature
Jayadevappa et al. (2011). Patient Centered Care – A Conceptual ...
PCCD – Patient Centered Care Delivery – 2022/2023 – SUM
Summary theme 1
Patient Centered Care (PCC) – ‘therapeutic alliance’ – a concept focussed on the individual patient as
decision maker within their own care process, given that they know best what they experience and
what they need. In such care is based on patient-specific information (understanding the patient),
informing the patient and respond to the patient’s needs and preferences. The concept is often
explicated through the 8 dimensions of PCC (Rathert et al.)
EMB – following the current best evidence (scientific) in making decisions about the care of patients.
– ‘little inconsistency among definitions – the conscientious, explicit, and judicious use of current
best evidence in making decisions.’
EBPCC – the integration of PCC and EMB – a framework of information management, built on the
needs of patients rather than the availability of evidence
Patient-centered medical home – a concept widely promoted as the basis for primary care reform.
The principle states that they include the voices of patients in decision making, accounting for all the
care needs of a patient; coordinated across all of the patient’s touchpoints within the healthcare
system. Intended to improve quality, efficiency, and patient experience of care – e.g., enhanced
access for routine primary care, improved delivery of preventative services, high-quality chronic
disease management, and reduced emergency department and hospital utilization
Literature theme 1
Rathert et al. (2013). Patient-Centered Care and Outcomes: A Systematic Review of the Literature
Aim: to distinguish dependent variables in terms of long- and short-term outcomes. It shows the
mechanisms through which PCC works, how it works and when it works best. In such it helps
healthcare practitioners to understand the differences in patients and what kind of processes work,
how they work and why they work.
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. – the patient as an experiencing individual beyond being just an object of
disease. – this means care providers must have an understanding of the patient’s context – a
therapeutic alliance – it would mean that providers are guests in the lives of patients.’ – “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”
Following the model of Donebedian (1988);
a good structure increases the likelihood of
good process, and good process increases
the likelihood of good outcome. In the
conceptual model here you can see the 8
different dimensions of PCC (process) and
their effect on the outcome. – patients
generally define PCC in terms of these 8
dimensions.
,The 8 dimensions:
1. Respect for patient preferences: getting to know the patient and their preferences and in
such deciding on treatment plant together (SDM)
2. Information, education and communication: Patients know best what their health condition
means to them, therefore we have to provide patients with the right information regarding
their disease, different treatment plans etc. In order for them to make the best decision for
them.
3. Physical comfort: not only in everyday life, but also when attending a healthcare facility,
caregivers must take into account the support needs. E.G., nice chairs, a clean environment
4. Emotional support: often, in the light of a disease, there are social and mental challenges in
place.
5. Involvement of family: depending on severity of the disease, often family is affected as well.
This could be through informal caregiving, but also because they could use some emotional
support themselves regarding the disease of a loved one.
6. Access to care: think about practicalities such as financial access, the ability to make an
appointment or use a webportal etc., ability to schedule a procedure on time or the
accessibility to a building.
7. Coordination of care: the planning of care, when does one need which form of care and
where. Is this organized in such a way that it’s easy for the patient to navigate through the
system/is the patient not send everywhere and getting nowhere?
8. Continuity & Transition: how different caregivers organize and share what they’ve done for a
patient in order for all caregivers to be up-to-date on the disease, treatment and history of a
patient.
Jayadevappa et al. (2011). Patient Centered Care – A Conceptual Model and Review of the State of
the Art
Aim: giving conceptual clarity for researcher, clinical practice and policy makers in understanding
how different dimensions of patient centered care will have an impact on improved outcomes and
resource utilization.
PCC – ‘implies individualized patient care based on patient-specific information rather than focusing
exclusively on the disease. The physician tries to see the illness through the patient’s perspective,
and is responsive to the patient’s needs and preferences.’
In this article the attributes of the patient are more explicitly named, their cultural background,
ethnicity etc. everything is of an influence on the type of patient centered care the patient requires.
The provider characteristics in the model here is the structure of the system that enables the degree
of patient centered care available, whereas the patient characteristics do as well by showing that
patient centered care means something different to all patients.
In the article underserved populations are explicitly named, given the cultural diversity and
the noticeable disparities in care between racial/ethnic/minority/poor in our healthcare system.
, Here you can also see the structure
(provider characteristics). You could
look at the structure as a
moderator for the process and
outcome (when comparing the
model to the model of Rathert).
Lacy et al. (2008). Evidence-based and Patient-centered Care: Results from an STFM Group Project
Aim: to identify the elements of a definition of evidence-based patient-centered care (EBPCC), the
barriers to using EBPCC, and strategies for overcoming these barriers.
EMB – ‘the conscientious, explicit, and judicious use of current best evidence in making decisions
about the care of patients.’
PCC – ‘the interweaving of six components: exploration of “both the disease and the illness
experience, understanding the whole person, finding common ground, incorporating prevention and
health promotion, enhancing the patient-doctor relationship, and being realistic.’
Integration: a framework of information management, built on the needs of patients rather
than the availability of evidence.
Either or model – each approach is distinct from the
other.
Integrated – two distinct approaches, with
overlapping spheres and in such a band of practice
was created in which practitioners apply concepts
from both spheres.
Continuum (balance) – suggests a point at which a
clinician incorporates both patient centeredness and
evidence-based medicine and that the best practice
involved balancing the two.
Cyclical – a process of active movement between the
two modes of operating.
The principal barriers to practicing EBPCC appear to be related to time restraints, relational
challenges, and finding common ground.
Strategies to overcome these barriers, aren’t well-developed. There isn’t enough knowledge
on the concepts to come to concrete strategies.
, Friedberg et al. (2014). Association between Participation in a Multiplayer Medical Home
Intervention and Changes in Quality, Utilization, and Costs of Care / Sinaiko et al. (2017). Synthesis of
research on patient-centered medical homes bring systematic differences into relief / Schwenk
(2014). The patient-centered medical home: One size does not fit
In these three articles the concept of a ‘patient-centered medical home’ is discussed.
Patient-centered medical home is a concept widely promoted as the basis for primary care
reform. The principle states that they include the voices of patients in decision making,
accounting for all the care needs of a patient; coordinated across all of the patient’s
touchpoints within the healthcare system. Intended to improve quality, efficiency, and
patient experience of care – e.g., enhanced access for routine primary care, improved
delivery of preventative services, high-quality chronic disease management, and reduced
emergency department and hospital utilization.
In all three articles it is stated that, although the concept promises a lot, not enough research has
been conducted to actually know if the proposed outcomes will be true in general.
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