Patient centered care
The Institute of Medicine has targeted patient-centered care as one of its six domains. Patient centered care invokes many descriptions that have yet to be fully defined. It implies that the focus is on the patient rather then the doctor, technology, records or even evidence based medicine. It suggests that emotions, culture and other human qualities are taken into account. Patient centered care allows for active patient involvement in the decision making and health care process.The Institute for Healthcare Improvement has stated that the patient shares some of the medical responsibility.
Patient responsibility can be as simple as relaying self reported symptoms to the healthcare provider. Ruland et al. in a randomized controlled clinical trial looked at a new interactive tailored patient assessment (ITPA) tool for oncology patients that allows them to prioritize their symptoms. A list of symptoms are presented electronically to the patient utilizing an alogrithmic tree approach so that only applicable data is viewed. This assessment was then given on paper to the clinical provider of the intervention group. Evaluation of symptoms with the SF36, CES-D depression scale, and Medical outcome study social support scale was obtained. The intervention group had more symptoms addressed and there was a decrease in symptom distress over time as opposed to the control group. The symptoms discussed included a patient centered approach involving self-care, mood/feelings, sense of control, spiritual needs and others. In this example, a patient centered approach appears to have facilitated improved clinical outcomes of decreasing patient distress.
A patient centered approach will need to be brought into the world of health information technology. Today it is thought to reside only in a personal health record. The patient is to stand alone or only send/recieve information from their own medical record. The record is about the patient. In order to make technology patient-centric, the patient will need to contribute to it. Assessments such as the ITPA are only one avenue by which patients can begin to be incoporated into HIT. Patient paper assessments were encorporated into the paper record and need to be re-captured in the electonic record. In order to merge the concept of patient-centered care with technology, future research is needed into patient portal views of their own medical record, patient data entry into the medical record, and patient communication within the medical record.
References: 1. Ruland CM, Holte HH, Roislien J, Heaven C, Hamilton GA, Kristiansen, Sandbaek H, Kvaloy SO, Hasund l, Ellison MC. Effects of computer-supported interacive tailored patient assessment tool on patient care, symptom distress, and patients' need for symptom management support: a randomized clinical trial. JAMIA. 2010;17:403-410 2.http://www.ihi.org/IHI/Topics/PatientCenteredCare/PatientCenteredCareGeneral/
Submitted by Jodi Kodish-Wachs