Thèses sur le sujet « Patient centeredne »

Patient centered care considers patients' values, personal preferences, cultural traditions and lifestyles when it comes to implementing care and treatments. This study looks at the effect of patient-physician race concordance on patient centered care and focuses on which ethnic backgrounds are more impacted by this concept. When patients feel they can relate to their care providers, they tend to report higher satisfaction rates when it comes to their treatments. Results of this study can be applied to future research revolving around patient centeredness and can be used to determine how to enhance patient centered care for all patients.

The purpose of this quantitative ex-post facto study was to determine if the level of satisfaction is increased over hospitals that do not incorporate PCC services. The study involved the use of archival data from HCAHPS (n.d.) satisfaction surveys analyzed during the first quarter of 2013. The respondents of the study included using archival patient satisfaction survey data from 113 hospitals within the State of Michigan. Fifty-two of these hospitals were identified as providing some level of PCC services to patients, and 61 of the hospitals were identified as not providing PCC services to patients. For each of the research questions, a two-sample t-test was used to compare the mean percentages between hospitals that have implemented PCC services and hospitals that have not implemented PCC services. The use of a two-sample test with all of the research variables did not reject any of the hypotheses for this study. This outcome could indicate that HCAHPS (n.d.) patient satisfactions scores may not be directly linked to PCC services. Although the results for this study did not demonstrate a favorable outcome regarding HCAHPS (n.d.) satisfaction scores and PCC services, the literature review for this study validates the importance for leaders within the health care community who have established PCC services to find other measurements to assess the effectiveness of PCC services, and those who do not to consider the implementation of Patient-Centered Care (PCC) services within their hospitals.

Patients and care providers fail to embrace the quality-driven relationships that were once part of the clinical consultation. To improve what some have referred to as a dampened relationship social scientists and medical professionals are pursuing a ‘patient-centered’ model where healthcare is delivered in ways that are “respectful and responsive to individual patient preferences, needs, and values” (Institute of Medicine 2001:6). The model sets standards for identifying and responding to patient concerns regarding illness and treatment, and cherishes the benefits of shared decision-making and responsibility (Epstein 2000). Undoubtedly, this model works best when the patient’s interest and values are central to the delivery of care.

A sample survey of 94 patients seeking treatment at an urban, hospital-based primary care clinic, are analyzed to answer three separate, but fundamental questions: 1) Is there a significant association between components of cultural capital (marital status and/or education) and patient-centered events? 2) Does the presence of any of these patient-centered events associate itself with a patient’s overall experience? And 3) is there a significant association between components of cultural capital and overall patient experience? I hypothesize that marital status and/or education are directly associated with the presence of patient-centered events, that the presence of any one patient centered event is positively correlated with the overall clinical experience, and that a patients overall experience is directly associated with marital status and/or education.

Today’s emerging patient centered health movement is focused not on a specific condition or demographic, but rather on shifting the balance of power and enabling access to information to drive decision-making in healthcare. This takes place through electronic health records as well as more generalized sources. The uptake of social media is contributing to an innovation in patient centered healthcare: information and support on a global scale is coming not only from the formal healthcare system, but also within online social networks. Today, through computer-mediated interactions, patients are not only seeking information, they are curating and sharing information. Subsequently, patients are also creating information, establishing a novel ecosystem of engagement that has the potential to disrupt the current healthcare system.

This dissertation explores an online health community, BCSM (which stands for “breast cancer social media”), established using Twitter, a largely public and searchable social media platform. Drawing primarily from social network theory, disruptive innovation, and ecological systems theory, this research identifies essential characteristics within the community that may inform future development and support for patient centered healthcare. To conduct this research, a blended approach of netnography – referring to the approach of ethnography applied to the study of online cultures and communities – and in-depth interviews with BCSM participants were employed.

Data collected via interviews and tweets using the hashtag #bcsm provide evidence of clinical support, emotional support, information sharing, and knowledge translation. Underpinning this activity is the opportunity to associate not only with peers, but also with individuals of varying roles (including patients, providers, advocates, researchers, and caregivers). As evidenced by the data collected, educational opportunities flow in both directions.

This work contributes to the larger corpus of health-related literature in the identification and naming of a significant community element that has seen little focused attention: cross-peer engagement, a term used to highlight the interaction amongst individuals of differing status, ability, or rank. This research also documents the formation of microspurs, defined as relationships that form as a result of community participation. These come in many forms and range from expanding a personal support network to participation in federal policy work. Findings suggest that the future of healthcare will not revolve around hospitals and bounded systems. Instead, patients will demand an expanded set of entry points for health information sharing, knowledge transfer, condition management, and general support.

This study investigated correlations between patient-centered qualities of primary-care providers (N = 64) and how those qualities correlated with 3 quantifiable patient-health outcomes as assessed through the aggregate data available in the electronic health records (EHR): Controlling high blood pressure, low density lipoprotein (LDL) management for diabetics, and hemoglobin A1c poor control for diabetics. Patient-centered qualities were defined as having the qualities of empathy, cultural competence, and mindfulness—the ability to be present in the moment in a nonjudgmental and accepting way. Through an online survey process, primary-care providers (PCP) completed the Jefferson Scale of Physician Empathy (JSE), the Cultural Competence Assessment (CCA), and the Freiburg Mindfulness Inventory (FMI). Providers were also asked about their level of Motivational Interviewing (MI) training and the level of MI use. OCHIN provided the researcher with the health outcomes data of the hypertension and diabetic patients on the panels of the participating PCPs. The correlations between provider scores on the surveys and the patient-health outcomes data were examined using Pearson's product-moment correlation coefficient (Pearson's r). Results showed a significant positive correlation between % diabetic LDL controlled and cultural competence (r = .285, p ≤ 0.05). Cultural competence was also non-significantly positively correlated with % blood pressure (BP) < 140/90 (r = .205). The research revealed a non-significant negative correlation between cultural competence and % HbA1c poor control (r = -.172).

It has been estimated that by 2020 nearly one-third of all Americans (almost 160 million people) will have at least one chronic disease to manage and the cost of health care will consume over 20 percent of the GDP. The Obama Administration responded to this pending crisis by passing the Patient Protection and Affordable Care Act (PPACA) in 2010. This major legislation aims to instill patient-centered, accountable care into the health care delivery system. Specifically, the United States government is on a mission to reduce the utilization of expensive inpatient care, while increasing access to primary care for all Americans, thereby lowering the total cost of health care.

Primary care practices organized around the principles of the patient-centered medical home (PCMH) can better manage their patients, especially their patients with chronic conditions; and become accountable for their care. In 2008, the National Committee for Quality Assurance (NCQA) released practice-level recognition standards based on the seven Joint Principles of the PCMH, to aid doctors seeking to transform their practices into effective patient-centered delivery systems.

The results of several published studies have touted the successes (e.g., reduced emergency department visits, reduced hospitalizations) of the PCMH model at individual practice sites. These localized successes demonstrated that the principle tenets of the PCMH model—care coordination, team-based care, population management—helped lower utilization of more expensive health care services within the specific practice settings evaluated. However, there has been no study to determine if these core tenets are having a broader impact on the health care delivery system within a community.

One hypothesized outcome of a health care system centered on the PCMH care model is better care coordination and more effective, whole-person care management across the continuum of health care; resulting in a more efficient system that can prevent avoidable hospitalizations.

This dissertation proposal seeks to understand if the increasing numbers (density) of recognized PCMH practices in communities affect avoidable hospitalizations related to ambulatory care sensitive conditions (ACSC), as measured by the AHRQ Composite Prevention Quality Indicators (PQI). The research has two purposes:

1. Establish constructs and hypotheses to measure the effect of the increasing numbers of NCQA-Recognized PCMH practices in communities (counties).

2. Using an outcomes-based measurement approach, investigate the relationship between growing densities of NCQA-Recognized PCMH practice doctors among all primary care doctors (PCD) in a community and the associated impact on the utilization of inpatient care, specifically related to ACSCs, as measured by the AHRQ Composite PQIs.

The research is quasi-experimental in design and is based on a retrospective (2008–2011) analysis of existing data from the NCQA PCMH program, the AHRQ Composite PQI and the Centers for Medicare & Medicaid Services (CMS) National Provider Identification (NPI) databases. Analysis will link NCQA-Recognized PCMH practices (independent variable), AHRQ Risk Adjusted Composite PQIs (dependent variable), and the CMS NPI (total PCDs) on Federal Information Processing Standard (FIPS) identifiers across 114 state and county-level geographical areas in Vermont and North Carolina. The research will inform the following hypotheses:

1. Does the research literature support the measurement construct proposed in this study?

2. Communities with concentrations of recognized PCMH practices among primary care practices will have lower risk-adjusted avoidable hospital admission rates.

3. The use of technology and care coordination will have a greater predictive correlation on risk-adjusted avoidable hospital admission rates than other PCMH capabilities.

Abstract Emergency medical services (EMS) for nonemergent or low-acuity calls is a new normal. EMS agencies spend a majority of time providing primary care services through the 911 system. They are utilized currently to fill the primary care gap subconsciously. The EMS system is activated as a patient navigator for primary care services. EMS agencies in the state where the research occurred have responded to the gap in care management by creating innovative programs such as community health emergency medical services (CHEMS). Creation of CHEMS programs have become one of the most monumental concepts for change in the field on both a state and national level. EMS has sought ways to meet the goals of the Triple Aim by exploring CHEMS as the state transitions to value-based care. Leaders are searching for innovative ways to close the gap in the primary health care system through a patient-centered medical home (PCMH) model. The action research study stimulated innovative thinking to support coordinated care across the evolving continuum of the health care system. The study captured the current awareness from community health care leaders who have had a recent opportunity to explore the idea of integrating EMS into the PCMH model through semi-structured interview sessions. Major findings in the thematical analysis discovered the current way both EMS and a PCMH function in a silo system that could potentially utilize each other to effectively provide managed care. Joint efforts could offset overutilization of EMS services for calls that have no apparent life threats. EMS would allow for a PCMH to conform to the Patient Protection and Affordable Care Act standards of care management, contributing to the integration of Triple Aim objectives. Collaboratively, EMS and an established PCMH will impact the delivery of preventative, quality and cost-efficient care. The theory of organizational culture change is based on three common characteristics: culture is shared, is intangible, and affects human behavior. The conceptual framework of the research study was based on the chronic care model. Patients with comorbidities potentially utilize the health care system more than a healthy patient to seek reassurance that their health is managed.