Theme 1
Patient Centered Care (Lacy)
- Exploration of both the disease and illness experience
- Understanding the whole person
- Finding common ground
- Incorporating prevention and health promotion
- Enhancing the patient-doctor relationship
- Being realistic
Two conceptual models (Rathert and Jayadevappa)
Rathert: Donabedian model
o Model focuses on good structure > good process > good outcome
o Patient journey focused, patient perspective
o Interpersonal processes: exchange of information, determine accurate diagnosis,
preferences and acceptability of care
o Technical: appropriate diagnoses and strategies for care
o Technical processes are implemented through interpersonal interactions, therefore, the
success of technical care depends on interpersonal processes
o Eight domains within the process
o Moderators affect direction of strength of the relationship
o Mediators are influenced by the process domains, but do not have a direct influence
on outcome
o Outcomes: patient satisfaction, patient clinical outcomes and organizational outcomes.
Jayadevappa: Conceptual model
o States that PCC requires level of commitment and adjustment in organization
structure, physician role and patient beliefs (integrating culture competence)
o Organization focused: how to organize patient centered care
o Domains that influence treatment choice, the process of care and the outcome
o Shared decision making, the patient:
1) understands the risk or seriousness of the disease;
2) understands the preventive service, including the risks, benefits, alternatives and
uncertainties;
3) has weighted his or her values regarding the potential benefits and harms
associated with treatment; and
, 4) has engaged in decision making at a level that he or she desires and feels
comfortable
o Tailored care to patient preferences; that takes into account clinical characteristics and
clinical convenience to minimize the costs and maximize the outcomes of survival
and satisfaction, integrating:
1) understanding the patient and the illness,
2) arriving at mutual understanding regarding illness management and therapeutic
alliance,
3) providing valued information,
4) enhancing hospital, doctor and patient relationship; and
5) sensitivity about resource allocation and cost.
Model integration:
Integration:
o Organizational outcomes are similar to costs
o Moderators and mediators are similar to patient characteristics and clinical
characteristics
o Patient and clinical outcomes are similar to outcomes presented
o The eight domains/dimensions can be integrated between provider characteristics as
part of the process to patient centered care
Jayadevappa:
Applicable in management/organizations setting because focus on cost as outcome
Rathert
Focuses mostly on interpersonal relationship and patient journey, making it best
applicable in the GP practice/consultation practice where there is a direct relationship
between the physician and the patient
Eight dimensions of PCC with examples
1. Patient preferences: The interaction between healthcare professionals and patients
Example: routine feedback/evaluations, ability to modify own schedule with respect to
food/visiting hours/sleep times etc
2. Information and education: understanding of information, evidence-based
information provided
Example: Publicly available information (e.g., flyers in different languages), modified information,
patient education, guidance
, 3. Access to care: care availability and transparency
Example: GP that visits you instead of you visiting them, short waiting times on the phone/email,
whatsapp helpline, disabled access
4. Emotional support: care should not only focus on physical elements but also
mental
Example: emotional support dogs in anxiety, psychologist visit for people with terminal disease
5. Family and friends: involve in decision making, provide structure for easy support
system
Example: elderly home combined with student homes, family guidance or counseling, opening
visiting hours
6. Coordination of care: clear communication between professionals and to patient
Example: follow-up, good communication to prevent
7. Physical comfort: think of emotional/physical needs that increase comfort
Example: beds in hospitals, air-conditioning, special service to patients with special needs
8. Continuity and transition: all correspondence between professionals
Example: sharing of data, scans etc to eliminate duplication of testing
Patient Centered Medical Home
“Holy grail” for transforming primary care; featuring comprehensive care, patient centered
care, coordinated care, accessible service, quality and service.
1. Comprehensive: The medical home is set up to meet the majority of patients physical
and mental needs. It works through a team of care providers, linking their patients to
providers and services in communities.
2. Patient centered: Active support in patient self-management, relationship-based care,
inclusion of families.
3. Coordinated care: Clear and open communication, broader health care system
coordination, facilitating transition between sites of care.
4. Accessible services: shorting waiting times, longer in-person hours, 24/7 access to
care team
5. Quality and safety: clinical decision support tools, measuring patient experience and
satisfaction, transparence of improvement activities
While all patients can benefit, majority only needs basic assessment, context matters!
No reductions in healthcare utilization, quality or costs
Difficult to assess over short-time period, volunteerism also plays a role
Patient Centered Care (Lacy)
- Exploration of both the disease and illness experience
- Understanding the whole person
- Finding common ground
- Incorporating prevention and health promotion
- Enhancing the patient-doctor relationship
- Being realistic
Two conceptual models (Rathert and Jayadevappa)
Rathert: Donabedian model
o Model focuses on good structure > good process > good outcome
o Patient journey focused, patient perspective
o Interpersonal processes: exchange of information, determine accurate diagnosis,
preferences and acceptability of care
o Technical: appropriate diagnoses and strategies for care
o Technical processes are implemented through interpersonal interactions, therefore, the
success of technical care depends on interpersonal processes
o Eight domains within the process
o Moderators affect direction of strength of the relationship
o Mediators are influenced by the process domains, but do not have a direct influence
on outcome
o Outcomes: patient satisfaction, patient clinical outcomes and organizational outcomes.
Jayadevappa: Conceptual model
o States that PCC requires level of commitment and adjustment in organization
structure, physician role and patient beliefs (integrating culture competence)
o Organization focused: how to organize patient centered care
o Domains that influence treatment choice, the process of care and the outcome
o Shared decision making, the patient:
1) understands the risk or seriousness of the disease;
2) understands the preventive service, including the risks, benefits, alternatives and
uncertainties;
3) has weighted his or her values regarding the potential benefits and harms
associated with treatment; and
, 4) has engaged in decision making at a level that he or she desires and feels
comfortable
o Tailored care to patient preferences; that takes into account clinical characteristics and
clinical convenience to minimize the costs and maximize the outcomes of survival
and satisfaction, integrating:
1) understanding the patient and the illness,
2) arriving at mutual understanding regarding illness management and therapeutic
alliance,
3) providing valued information,
4) enhancing hospital, doctor and patient relationship; and
5) sensitivity about resource allocation and cost.
Model integration:
Integration:
o Organizational outcomes are similar to costs
o Moderators and mediators are similar to patient characteristics and clinical
characteristics
o Patient and clinical outcomes are similar to outcomes presented
o The eight domains/dimensions can be integrated between provider characteristics as
part of the process to patient centered care
Jayadevappa:
Applicable in management/organizations setting because focus on cost as outcome
Rathert
Focuses mostly on interpersonal relationship and patient journey, making it best
applicable in the GP practice/consultation practice where there is a direct relationship
between the physician and the patient
Eight dimensions of PCC with examples
1. Patient preferences: The interaction between healthcare professionals and patients
Example: routine feedback/evaluations, ability to modify own schedule with respect to
food/visiting hours/sleep times etc
2. Information and education: understanding of information, evidence-based
information provided
Example: Publicly available information (e.g., flyers in different languages), modified information,
patient education, guidance
, 3. Access to care: care availability and transparency
Example: GP that visits you instead of you visiting them, short waiting times on the phone/email,
whatsapp helpline, disabled access
4. Emotional support: care should not only focus on physical elements but also
mental
Example: emotional support dogs in anxiety, psychologist visit for people with terminal disease
5. Family and friends: involve in decision making, provide structure for easy support
system
Example: elderly home combined with student homes, family guidance or counseling, opening
visiting hours
6. Coordination of care: clear communication between professionals and to patient
Example: follow-up, good communication to prevent
7. Physical comfort: think of emotional/physical needs that increase comfort
Example: beds in hospitals, air-conditioning, special service to patients with special needs
8. Continuity and transition: all correspondence between professionals
Example: sharing of data, scans etc to eliminate duplication of testing
Patient Centered Medical Home
“Holy grail” for transforming primary care; featuring comprehensive care, patient centered
care, coordinated care, accessible service, quality and service.
1. Comprehensive: The medical home is set up to meet the majority of patients physical
and mental needs. It works through a team of care providers, linking their patients to
providers and services in communities.
2. Patient centered: Active support in patient self-management, relationship-based care,
inclusion of families.
3. Coordinated care: Clear and open communication, broader health care system
coordination, facilitating transition between sites of care.
4. Accessible services: shorting waiting times, longer in-person hours, 24/7 access to
care team
5. Quality and safety: clinical decision support tools, measuring patient experience and
satisfaction, transparence of improvement activities
While all patients can benefit, majority only needs basic assessment, context matters!
No reductions in healthcare utilization, quality or costs
Difficult to assess over short-time period, volunteerism also plays a role
