Blog | Tuesday, March 13, 2012

How do we make sure health care is patient-centered?


A post on the Health Affairs Blog, "Patient-Centered Care: What it Means and How to Get There," is a nice summary of the importance of a field that I happen to be involved in. However, some false notes are sounded and I think it's worthwhile to correct them.

"At a recent symposium concerning both saving money and improving patient care, Health Affairs Editor-in Chief Susan Dentzer stated, 'It is well established now that one can in fact improve the quality of health care and reduce the costs at the same time.' This is exactly the principle behind the growing movement toward patient-centered care."

First of all, I don't think it's very well established at all that improved quality can be made to co-exist with reduced cost. Certainly we hope that is true, but it doesn't seem to be established yet. For example, a recent study of pilot projects implementing accountable care organizations, the great hope of cost-cutters, care organizers, and health policy wonks everywhere, found that they didn't save all that much money. Plenty of concern has already been aired that improved access, to care in general and preventive services in particular, will cost more on the front end, not less.

Second, I hope that the cost-cutting-and-care-improving "principle" isn't the one behind any movement toward patient-centered care. Rather, I would hope that patient-centered care is a sufficient end in itself.

Moving on, towards the end of the post, there is a paragraph that throws me for a loop.

"Doctors practicing patient-centered care have systems in place to continually measure patient perceptions. On-line tools are often used and questions are related to patient satisfaction and other care parameters. Moore and Wasson, in their study, The Ideal Medical Practice Model: Improving Efficiency, Quality and the Doctor-Patient Relationship, document improved patient satisfaction and education using a simple on-line tool. It is important to remember that patient-centered care revolves around continually questioning patients to assess their needs and the effectiveness of the care they are receiving."

If you follow the links, you get to a perfectly reasonable article from 2007 from the Journal of the American Academy of Family Practice, which includes an online tool to help patients organize their care. However, the placement of this link in the paragraph implies that this is the "[system] in place to continually measure patient perception." As I pointed out in an earlier post at KevinMD, the only "system" in wide use are Press-Gany and CAHPS surveys, which tend to be mail-based, have poor response rates, and measure "patient perception" in only a limited number of domains.

So with regard to making patient-centered care a matter of prime institutional importance and real-time reporting, we still have a way to go. As large academic institutions like mine make their way towards unified EMRs, implementing measures of patient perceptions--no, not just perceptions, but actual patient-centered care--will be an important part of the change, if we can make it happen.

Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews. He is also a poet, journalist and translator in Yiddish and English. This post originally appeared at his blog.