- 2016 will be the year of the patient.
- Technology is an excellent tool for practicing patient-centered medicine and improving patient satisfaction..
- A variety of 2016 care standards emphasize clinically appropriate care, physician timeliness, and patient access.
- From the Joint Commission to the AAFP to the CDC all major medical groups are emphasizing the need for ease of access to care, ease of communication, and appropriateness of care.
- The overall goals are to improve patient satisfaction and clinical outcomes, while reducing the cost of care.
The National Committee for Quality Assurance (NCQA) has published its 2016 health plan accreditation standards. The NCQA joins other major societies, associations, and accreditors in emphasizing the need to improve the patient experience of medical care. The new standards are designed to enhance patient access to clinically appropriate care.
“Patients are at the center of everything NCQA does, and the 2016 health plan standards highlight patients as our priority,” said NCQA Vice President for Product Development, Patricia M. Barrett. “We want patients to be confident that their NCQA-Accredited plan will keep them at the center of every coverage decision they make,” according to an NCQA press release.
The Basics of Patient-Centered Care
One of the basic tenets of patient-centered care is that patients are the best judges of the quality of care. Along with cost and outcomes, it is the patient’s view of the quality of healthcare delivery that matters most. The patient’s view that of quality that correlates with outcomes and satisfaction. That’s right, according to a study by Stewart et al from 2000 found that patient-centered care improves outcomes.
According to an article published in the Journal of Family Practice:
This fundamental tenet of patient-centered care was tested by Stewart, et.al. in 2000. Experts studied audio taped doctor-patient interactions while patients also rated these same interactions. Expert opinion could not be correlated with positive results, but patient-perceived patient-centered care correlated with “better recovery from their discomfort and concern, better emotional health 2 months later, and fewer diagnostic tests and referrals.”
This same phenomenon can be seen when studying physician empathy. Researchers at Thomas Jefferson University developed the Jefferson Scale to test physician empathy. Physicians rated their own empathy, and the scale could not be correlated with improvements in patient care. However, researchers then changed it to the Jefferson Scale of Patient’s Perceptions of Physician Empathy and administered it to patients. Suddenly, the tool was useful for predicting patient outcomes.
Use Technology to Benefit Patients
Many clinicians feel that technology is an impediment to patient centered care. While this can be true in some cases, there are clearly technologies that help clinicians keep track of patients, help patients feel that they are at the center of care, and not interrupt the physician-patient relationship.
Many physicians use Twitter, Facebook, and other social media to stay in touch with patients. While these may not be HIPPA compliant communications tools, they are tools that medical practices can use to stay in touch with patients and help patients feel that they are the focus of the practice. These media can be used to send appointment reminders, to broadcast news about the practice, to wish patients happy birthday, and to generally feel that care providers are focused on patients.
Telehealth has become a tool for both patients and physicians to stay in touch. Years ago, it was criticized for being cold. Today, improvements in technology have enabled telehealth to be a way to significantly expand access to care, to reduce the cost of routine care, and to help patients feel that they are at the center of the healthcare picture.
Text Messaging
An everyday technology like text messaging can be used to improve the care of a variety of patients. For instance, Partners Healthcare in Boston is using cell phones, text messaging, and virtual medicine to improve patient satisfaction, to stay in touch with pregnant patients, and to help them feel that they are the focus of the medical practice. According to the Partners website, “At the Lynn Community Health Center, in an urban community north of Boston, a text messaging program offers young, at-risk pregnant patients support, motivation, and timely education when they need it most.”
Text messaging programs have also been used to improve self-care behavior among patients. A Partners Healthcare text messaging program nearly doubled the adherence of patients applying sunscreen; another program significantly improved treatment adherence, skin severity, and quality of life for dermatology patients with atopic dermatosis. Patients enrolled in an opioid addiction treatment program felt better connected to case managers.
Change the Way You Practice
Many innovative healthcare providers have devised ways to change the usual practice patterns and to come up with healthcare models that save time for patients, give them more time with care providers, and also make the job of the providers easier. (See our article on Diabetes Day at Montefiore hospital in Bronx, NY.)
Once a month, Montefiore Medical Center hosts Diabetes Day. “On this day, the clinic shuts down its doors to its usual patients and invites patients with a hemoglobin A1C >8 to come for a visit,” explained Alok Sharan, MD. “The patients start the day by meeting the ophthalmologist, podiatrist, endocrinologist, nutritionist, and social worker,” he explained. “The last visit of the day is with the primary care physician who reviews all the notes from the previous specialists before ending the visit.”
The American Diabetes Association
The American Diabetes Association (ADA) is similarly emphasizing the need to improve the patient experience. The focus on the patient is evident in the ADA press release announcing the new standards. “The 2016 Standards of Care also tailor diabetes treatment to improve care among vulnerable populations. Clinicians are given guidance on treating ethnic, cultural, gender, socioeconomic differences and disparities. There is also guidance regarding food insecurity, cognitive dysfunction, mental illness, and patients with HIV who also have diabetes,” the ADA stated.
American College of Surgeons
The American College of Surgeons (ACS) is also emphasizing the need for patient-centered care in its 2016 publication, Cancer Program Standards: Ensuring Patient-Centered Care. According to the ACS:
The standards provide clear guidance to support the provision of high-quality care. Providing a high level of quality care requires coordination of care among many medical disciplines, including physicians ranging from primary care providers to specialists in all oncology disciplines. In addition, care requires input from many other clinical and allied health professionals, including nursing, social work, genetics, nutrition, rehabilitation, and others.
Key standards require programs in patient-centered areas including the provision of treatment and survivorship plans, palliative care services, genetics services, navigation programs, and psychosocial distress screening. Key quality measurement and outcome standards require performance levels on quality metrics as defined by the data collected by the cancer program’s cancer registry, along with suggested mechanisms to help the cancer committees address deficiencies in performance.
