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Putting People at the Heart of Healthcare

Putting People at the Heart of Healthcare
Author Information (click to view)

Laura Mosqueda, MD, FAAFP, AGSF

Associate Dean of Primary Care
Chair and Professor of Family Medicine and Geriatrics
Keck School of Medicine
University of Southern California

Laura Mosqueda, MD, FAAFP, AGSF, has indicated to Physician’s Weekly that the work described in this article was supported by a grant from the SCAN Foundation (TSF). Dr. Mosqueda also is an investigator on another contract funded by TSF and was invited by TSF to speak at their board retreat meeting and their long-term care summit meeting on the present study.

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Laura Mosqueda, MD, FAAFP, AGSF (click to view)

Laura Mosqueda, MD, FAAFP, AGSF

Associate Dean of Primary Care
Chair and Professor of Family Medicine and Geriatrics
Keck School of Medicine
University of Southern California

Laura Mosqueda, MD, FAAFP, AGSF, has indicated to Physician’s Weekly that the work described in this article was supported by a grant from the SCAN Foundation (TSF). Dr. Mosqueda also is an investigator on another contract funded by TSF and was invited by TSF to speak at their board retreat meeting and their long-term care summit meeting on the present study.

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Putting people at the center of healthcare may seem intuitive, but it’s an approach that has not been widely practiced in the medical community. Instead, we clinicians often prioritize and provide healthcare based on the needs of our systems, staff, and providers. While cultural change movements and emerging perspectives on chronic care management have guided medicine toward approaches like person-centered care to promote well-being, the approach has lacked a cohesive definition until now. A review of research published between 1990 and 2014 identified more than 15 distinct descriptions of person-centered care for older adults.

 

A Better Definition

An interprofessional panel of eldercare experts convened by the American Geriatrics Society, in collaboration with the Keck School of Medicine and Davis School of Gerontology of the University of Southern California (USC) and with support from the SCAN Foundation, has released findings from a project to better define “person-centered care” and identify its key elements. As described across four articles published in the Journal of the American Geriatrics Society, person-centered care involves putting an individual’s values and preferences at the heart of decision-making, achieving success by engaging in a collaborative and communicative approach to address patients’ goals and involve them (and those close to them) to the extent they desire.

A person-centered approach to caring for older adults with chronic complex illnesses begins by gathering specific information about preferences in light of health circumstances, with input from family members and other caregivers. When added to a comprehensive health and functional assessment, this information can be used to help a patients shape and articulate their goals.

To arrive at its definition, the research team at USC performed a comprehensive literature review that was supplemented by interviews with leaders of community-based healthcare and social service organizations. The research also took into account reported provision of person-centered care for older adults. From this work, it was found that organizations often define and operationalize person-centered care in unique ways. For some, its focus is on creating “individualized plans” while for others, it reflects the belief that person-centered care is not just a program but a culture embedded in practice and mission-driven.

 

Commitment Required

Despite variations in definitions and the costs of initial implementation, it is important for all clinicians to be strongly committed to this approach. Staff can build trust and a relationship with clients. In turn, clients can get better and personnel often feel better about client outcomes. A consensus definition based on these insights is necessary to build a firm foundation for the future of respectful, responsive healthcare. The expert panel developed a definition and eight essential elements of person-centered care that can help advance the definition from theory to practice:

  1. An individualized, goal-oriented care plan based on the patient preferences.
  2. Ongoing review of goals and care plans.
  3. Care supported by an interprofessional team in which the patient is an integral team member.
  4. One primary point of contact on the healthcare team.
  5. Active coordination among all healthcare and supportive service providers.
  6. Continual information sharing and integrated communication.
  7. Education and training for providers and, when appropriate, patients and those important to them.
  8. Performance measurement and quality improvement using feedback from patients and caregivers.

With this new definition of person-centered care—care in which individuals’ values and preferences are elicited and, once expressed, guide all aspects of their healthcare, supporting their realistic health and life goals—there is now a clearer vision of how to translate the aspirations of this approach into reality. New engagement strategies are needed and will require time and experience to master, but now is the time for a national dialogue about a better and more cost-effective approach to care. Clinicians need to consider medical conditions, functional abilities, and social support. This is ultimately guided by individual goals, dignity, and choices.

Readings & Resources (click to view)

Coulourides KA, Wilber K, Mosqueda L. Person-centered care for older adults with chronic conditions and functional impairment: a systematic literature review. J Am Geriatr Soc. 2016;64:e1-e7.

 

American Geriatrics Society (AGS) Expert Panel on Person-centered Care. (2016). Person-centered care: a definition and essential elements. J Am Geriatr Soc. 2016;64:15-18.

 

Coulourides KA, Wilber K, Mosqueda L. Moving toward implementation of person-centered care for older adults in community-based medical and social service settings: “You only get things done when working in concert with clients.” J Am Geriatr Soc. 2016;64:e8-e14.

 

Westphal, E.C., Alkema, G., Seidel, R., & Chernof, B. How to get better care with lower costs? See the person, not the patient. J Am Geriatr Soc. 2016;64:19-21.

 

Additional professional and public education resources available at: www.GeriatricsCareOnline.org and at www.HealthinAging.org.

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