Patient-centered care: Would you know it if you saw it?

Everybody talks about “patient-centered care” but who can easily say what it means? Now a paper in the Summer 2012 issue of The Permanente Journal provides a general framework for patient-centered care, describing how and why it happens at Group Health. It states that patient-centeredness is a “systems property” here—one that we’re working to “fully embed into the culture and fabric of the organization.”

The paper was written by Sarah M. Greene, MPH, Leah Tuzzio, MPH, and Dan Cherkin, PhD. Sarah is director of strategy and business development for Group Health and an affiliate faculty member at Group Health Research Institute (GHRI). Leah is a GHRI project manager who has worked on many studies of patient experience, and Dan is a GHRI senior investigator whose research interests include patient/provider interactions.

The trio developed the framework by reviewing the literature, conducting patient focus groups, and consulting with colleagues and advisers at Group Health and nationwide. Their definition of patient-centered care, adapted from one developed by the Institute of Medicine, reads: “care that honors and responds to individual patient preferences, needs, values, and goals.”

What does patient-centered care look like in everyday practice? Sarah, Leah, and Dan wrote that attributes can be categorized in three dimensions: 1) interpersonal, such as the strength of relationships among patients, providers, and staff; 2) clinical, such as how care is delivered and supported; and 3) structural, such as issues of built environment, access to care, and information technology. Patients may experience these dimensions independently or as part of an integrated system. A patient may have a great visit with his or her doctor, but be challenged by the physical layout of the facility. Innovations in information technology may allow patients convenient access to their medical records, but a brusque clinician can imperil the sense of connection that’s part of patient-centered care.

The authors provide concrete examples of changes Group Health has made to become increasingly patient-centered. These range from redesigning billing statements and signage to providing “patient-centeredness training” for nurses caring for chronically ill people. Leveraging communications technology (secure e-mail, Web-based care management, smartphone apps, etc.) is key. So are innovations in the patient-centered medical home.

Sarah and her colleagues found two fundamental tenets throughout patient-centered care: consistency and trust. They write: “Whether the patient is communicating with a physician or a radiology technician or a claims adjuster, whether being seen for a lifelong condition or an acute illness, whether the ‘visit’ is in a clinic or via e-mail, and whether the patient’s preferences are stable or change according to their heath status, the patient should be able to rely on the health system to consistently provide a patient-centered experience.” Trust comes from knowing the organization is providing good-quality, safe, well-coordinated care.

Recognizing that patient-centeredness is equally vital to research, GHRI recently submitted several applications to the new Patient Centered Outcomes Research Institute (PCORI). This federally funded nonprofit organization, which I described in a recent column, aims to focus on the issues that matter most to patients. Many at GHRI spent the last several weeks exploring ways to involve patients more fully in research projects—engaging them in developing scientific questions and disseminating and translating study results. We won’t know for some time whether our first PCORI applications will be funded, but regardless, we’re gaining awareness of how to engage patients early and throughout our research proposals with an aim to put patient interests first.

In the meantime, we continue to pursue patient-centered research. Our studies of shared-decision making, architectural design of patient-care facilities, the medical home model, value-based benefit design, and information technologies like Group Health's patient website are key examples.

We believe Group Health, as a “learning health system” is an optimal setting for such research. See the August 7 Annals of Internal Medicine for another article by Sarah (along with Group Health Medical Director for Research Translation Rob Reid, MD, PhD, and me), which describes how our organization is evolving to encourage continuous discovery and continuous improvement for better patient care.

Becoming more patient-centered will help guide Group Health and GHRI in our urgent work to improve cost, quality, and access. And it can help us discover innovative ways to better meet the needs of an aging and increasingly diverse population. This goal, along with our traditional emphasis on prevention and health promotion, aligns perfectly with our mission.

As our figure in the Annals paper shows, our efforts will remain an iterative work-in-progress. The art of providing patient-centered care and research depends on our ability to keep listening and learning from those who depend on us for their health and well-being.

—Eric