Patient - Centered Health Care

As the United States debates how to reorganize its health care system, policy makers must ask what patients really want and need from their primary care providers. There is often a disconnect between what patients say they want and what other providers or payers think patients want. Our research at the National Partnership for Women and Families suggests that a truly patient-centered health care system must be designed to incorporate features that matter to patients—including “whole person” care, comprehensive communication and coordination, patient support and empowerment, and ready access. Without these features, and without consumer input into the design, ongoing practice, and evaluation of new models, patients may reject new approaches such as medical homes and accountable care organizations. R edesigning the U.S. health care system to improve quality and use resources more effectively has taken on increasing urgency. Costs continue to rise, and patients struggle in a nonsystem that they say often fails to address their most pressing needs. As a result, there iswidespread agreement that health care should be anchored in a stronger primary care systemand thatprimary care itself shouldbe more patient centered. Models such as the patient-centered medical home and accountable care organizations are being developed and tested at the local, state, and national levels as promising approaches to use in advancing and achieving these goals. Historically, consumers have not been engaged in the design of new health care delivery and payment models. When they have been engaged, it has been mostly after physicians, employers, or health plans have constructed a new model. Then consumerengagementhas typically been conducted under the guise of “education” and designed primarily to convince or compel consumers to participate in it. This is an oftrepeated pattern in health care, reflecting the pervasive notion that if we simply build a system the “right way,” patients will embrace it. The problem with this approach is that nonconsumer stakeholders often don’t know what matters to patients in terms of what has themost impact on their ability to get and stay well. For example, in research regardingmedical decision making, Karen Sepucha and colleagues found significant differences between physicians’ understanding of patients’ values and what patients said is actually important to them. In explaining treatment options, providers tended to focus more on the benefits of a particular course of treatment, while patients most wanted to know about potential harms and effects on their daily activities. With information about all of their options, patients may make different treatment choices than physicians surmise. Patients’ desire for information on all of their options should not be interpreted to suggest that providers should simply give patients whatever treatment they want. There can be no doubt that patients and families rely on clinicians for guidance. At the same time, they also want a full understanding of options, benefits, and risks so that they can decide with clinicians what is doi: 10.1377/hlthaff.2010.0305