Patient-centered care has now made it to center stage in discussions of quality. Enshrined by the Institute of Medicine’s “quality chasm” report as 1 of 6 key elements of high-quality care,[1][1] health care institutions, health planners, congressional representatives, and hospital public

https://www.annfammed.org/content/annalsfm/9/2/100.full.pdf

The Values and Value of Patient-Centered Care

Background.Health care organizations face pressures from patients to improve the quality of care and clinical outcomes, as well as pressures from managed care to do so more efficiently. Coordination, the management of task interdependencies, is one way that health care organizations have attempted t

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Impact of relational coordination on quality of care, postoperative pain and functioning, and length of stay: a nine-hospital study of surgical patients

Many people living with chronic conditions have multiple chronic conditions. Multimorbidity is defined here as the co-existence of two or more chronic conditions, where one is not necessarily more central than the others. Multimorbidity affects quality of life, ability to work and employability, disability and mortality. Currently, clinicians have limited guidance or evidence as to how to approach care decisions for such patients. Understanding how to best care and design the health system for patients with multimorbidity may lead to improvements in quality of life, utilization of healthcare, safety, morbidity and mortality. The objective of this paper is to review the implications of multimorbidity for the design of health system and to understand the research needs for this population. The consideration of people with multimorbidity is essential in the design and evaluation of health systems. Fundamentally, people with multimorbidity should receive a patient — and family-centered approach to care throughout the health system, and understanding how to deliver this type of care in effective and efficient ways is an enormous challenge, and opportunity, for clinicians, researchers, and policy makers today.

/pdf/future-of-multimorbidity-research-how-should-understanding-2sig3qsmzy.pdf

Future of multimorbidity research: how should understanding of multimorbidity inform health system design?

Family presence in routine medical visits: A meta-analytical review

Background Sicker patients are less satisfied with the quality of health care they receive than their healthier counterparts. Methods A sample of 12 018 community-dwelling Medicare beneficiaries 65 years or older from the 2004 Medicare Current Beneficiary Survey was studied. Multivariate regression was used to describe whether beneficiaries' self-reported satisfaction with their usual-care physician was related to the presence or functions assumed by visit companions. Results Overall, 38.6% of beneficiaries reported being typically accompanied to routine medical visits. Accompanied beneficiaries were older, less educated, and in worse health than their unaccompanied counterparts. More than 60% of companions facilitated visit communication by recording physician instructions (44.1%), providing information regarding patients' medical conditions or needs (41.6%), asking questions (41.1%), or explaining physicians' instructions (29.7%). After controlling for sociodemographic and health differences, accompanied beneficiaries were more highly satisfied with their physician's technical skills (odds ratio [OR], 1.15; 95% confidence interval [CI], 1.02-1.30), information giving (OR, 1.19; 95% CI, 1.05-1.35), and interpersonal skills (OR, 1.18; 95% CI, 1.03-1.35) than unaccompanied beneficiaries. Accompanied beneficiaries whose visit companions were more actively engaged in communication rated physician information giving (OR, 1.42; 95% CI, 1.14-1.77) and interpersonal skills (OR, 1.29; 95% CI, 1.05-1.59) more favorably. This relationship was strongest among beneficiaries with the worst self-rated health. Conclusions Visit companions are commonly present in older adults' routine medical encounters, actively engaged in care processes, and influential to patients' satisfaction with physician care. More systematic recognition and integration of visit companions in health care processes may benefit quality of care for a particularly vulnerable patient population.

https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/414353/ioi80035_1409_1415.pdf

Thomas J Martz

Papers

Through the Patient's Eyes: Understanding and Promoting Patient-Centered Care

The Impact of Managed Care on the Practice of Psychotherapy; Innovation; Implementation; and Controversy