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THE FUTURE OF PATIENT-CENTERED CARE

The concept of patient-centered care was designed to be a guiding principle for positive transformation in medical care.

The concept of patient-centered care was designed to be a guiding principle for positive transformation in medical care. “Patient-centered care”, with its “sibling” concept, the “medical home,” has been an organizing principle energizing thousands of hours of effort and millions of dollars in spending toward quality improvement, particularly in primary care. Unfortunately, after all the time and money expended, the medical home effort, changing practice patterns to improve information management,

coordination of care, and access, has been much more successful than the patient-centered care effort with its goal of changing the relationships between patients and health professionals to improve transparency, accommodate to patient preferences and values, and make the patient the “source of control” in planning care. This is especially true about the care of patients we term “multiply-disadvantaged”* patients. For these patients, the Institute of Medicine’s call for the patient to be empowered in designing their care, including having the information and experience of self-efficacy needed to participate as a partner with their healthcare team, is a sine qua non. Health settings that approach these patients only by “adding services” are much less likely to be successful than programs that train a team of health professionals to change their relationship approach toward these patients. Facilitating this relationship change is the future of patient-centered primary care.

“Multiply-disadvantaged” is a term for patients termed “complex” in literature about high utilizing people with multiple chronic illnesses and behavioral health needs. These same patients are described in literature on disadvantaged patients coping with lives of poverty and bias. And finally, these same patients are very highly likely to be described in literature on victims of trauma who need to be offered Trauma-Informed Care.

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Patient-Centered Primary Care, Getting from Good to Great helps primary care practices involve patients as partners in their own healthcare in ways shown to improve health outcomes and lower costs.

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This is especially true for multiply-disadvantaged patients, the group with the highest costs and at risk for the worst outcomes. PCPCG2G offers a summary of the approaches that are currently in growing use such as: health literacy assessment, motivational interviewing, appreciative inquiry, shared decision making, minimally disruptive medicine, trauma-informed care, enfranchisement coaching, relationship-centered care, and family-informed care. Finally, it offers a transformative method for building partnerships with multiply-disadvantaged patients, an approach that is Transparent, Empowering, Activating, and Mutual: The T.E.A.M. Way. 

WHAT PEOPLE SAY

“After reading the book, I recognized that I totally missed the boat in understanding non-compliance in patient care and felt truly enlightened by Dr. Blount’s explanations related to multiply disadvantaged patients… Excellent examples with very down to earth language that I think docs can relate to. I am sensing that this book would be THE manual for change facilitators once the practice administration buys into these principles.”

David Artzerounian, MD

Chief Medical Officer (Ret.), Massachusetts Mutual Corp.

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