Thursday, August 19, 2010

More on Patient Centered Care & Homes

Here is an op-ed piece that I wrote some time ago that unfortunately didn't get published. However, this blog is a great place to put it!

Patient-Centered Health Care

Patient centered. To the average health care consumer, the notion that they themselves are the main focus of the care received is a no-brainer. However, the reality that exists in health care today is quite the opposite. More often, interacting with the current health care system is often a deeply dissatisfying and frightening experience, fraught with errors, miscommunication and waste. As a community-based nurse practitioner for 10 years, I practice within the fragmented confines of an inefficient and costly system and know how this current system is too often harming people. Fundamental reform is needed. According to the Institute of Medicine, care is often delivered in silos producing poorly coordinated and overly complex care. The current healthcare system is fraught with opacity and is unnavigable for most of us. For example, oftentimes patients don’t know how much a procedure or office visit will cost.

I imagine a near Utopian health care system where a patient can complete registration forms just once, have their complete health record accessed from virtually any Internet connection, communicate with their providers at their convenience and have their care coordinated by a team of professionals whose main objective is to improve health outcomes, decrease costs and deliver patient-centric, evidence- based health care. Such a system is currently undergoing pilot studies known as the Medical Homes Demonstration Project.

The time and cost savings potential of these Homes are virtually limitless. Technology will play a major role within the Homes, allowing for health systems to engage in rapid learning, so common in other industries. For example, imagine visiting your health care home, and then reviewing your laboratory results online the next day while your health care provider explains the meaning of the results by phone or by instant message. Text message alerts can be used to remind you when it is time to take your medications or get a colonoscopy. More importantly, practices will be better able to track the outcomes of care they are providing and consumers will be easily able to compare health care homes for quality.

Patients who are members of a patient centered home will take far more responsibility for the direction of their care. Gone will be the days of asking for the latest and most expensive and largely unproven medication because of their fancy commercials. Patients will have the opportunity to hear and evaluate the evidence for their condition and will make informed decisions, just as when you go to an accountant or lawyer, who provide options and a cost-benefit analysis.

Continuity of care will also be a hallmark of the Home. Your team of providers will know you and your medical history. Visits to specialists, dentists, and other health care professionals will be coordinated and integrated into a single repository of your health data. Along with the team, you will make the important health decisions.

The Medical Homes Demonstration Project is an exciting model of team-based, coordinated, high-quality and cost-efficient care. While the initiatives in the model aren’t new, the collective sum is unlike anything we have today. We a model that is patient-centered and where the exchange of data is efficient, coordinated and examined so the optimal care is delivered for that individual, time and place. We also need to ensure that the foundations of the homes are sound. That is, the physicians and nurse practitioners guiding the care must be available to care for the many patients who will utilize this model. Finally, for true health reform all the stakeholders – patients, clinicians, lawmakers and insurers must be willing to work together. Every American should have a such a home.

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