ABIM: Patient centered care is crucial in health reform

A guest column by the American Board of Internal Medicine, exclusive to KevinMD.com.

by Christine Cassel, MD

ABIM: Patient centered care is crucial in health reformThe concept of patient-centered care was catapulted into the mainstream by the publication in 2001 of the seminal Institute of Medicine report Crossing the Quality Chasm: A New Health System for the 21st Century.  This report identified six aims of improvement for the U.S. healthcare system by asserting that care must be: safe, effective, patient-centered, timely, efficient and equitable.

A definition of patient centered care advanced by the Institute for Health Care Improvement (IHI) includes consideration of “patients’ cultural traditions, their personal preferences and values, their family situations, and their lifestyles.  It makes the patient and their loved ones an integral part of the care team who collaborate with health care professionals in making clinical decisions… [and] ensures that transitions between providers, departments, and health care settings are respectful, coordinated, and efficient.  When care is patient centered, unneeded and unwanted services can be reduced.”

In other words, a truly patient-centered health care system may provide higher quality health care, improve patients’ experiences and increase efficiency.

The American Board of Internal Medicine has integrated patient-centeredness into its Maintenance of Certification program by including patient experience surveys in most of its practice performance tools.  Other American Board of Medical Specialties boards are doing the same.

Patient-centeredness is also integrated into a number of health reform initiatives.  The Patient Protection and Affordable Care Act includes a number of innovative pilot programs that will evaluate the Patient-Centered Medical Home.  The law also calls for the creation of a “Physician Compare” website, which will allow the public to compare quality data at the physician level, including “an assessment of patient experience and patient, caregiver, and family engagement.”

As I was reflecting on the crucial role of patient-centered care in health reform, I remembered Don Berwick’s inspiring lecture at ABIM Foundation’s 2008 Forum entitled “What ‘Patient-Centered’ Should Mean: Confessions of an Extremist” (later published in Health Affairs).   During his speech, Dr. Berwick proposed that the patient should truly be at the center of the health care system:

“For better or worse, I have come to believe that we—patients, families, clinicians, and the health care system as a whole—would all be far better off if we professionals recalibrated our work such that we behaved with patients and families not as hosts in the care system, but as guests in their lives.  I suggest that we should without equivocation make patient-centeredness a primary quality dimension all its own, even when it does not contribute to the technical safety and effectiveness of care.”

This vision is a far cry from critics’ claims that Dr. Berwick wants to ration care.  In fact, anticipating the criticisms of people in the room, he cited studies that show the connection between patient-centered care and effectiveness and efficiency.  And Dr. Berwick’s leadership at IHI has embodied this vision which I hope he can also bring to fruition in his new role as the Administrator of the Centers for Medicare and Medicaid Services.

Truly patient-centered health reform has the potential to achieve the “Triple Aim” that has thus far been so elusive – improving patients’ experience, bettering the health of our nation as a whole, and reducing health care costs.  At a time when – as a recent Commonwealth Fund study shows – the United States ranks last or next-to-last in quality of care measures when compared with 5 international systems (Australia, Canada, Germany, Netherlands, New Zealand and the United Kingdom), and policymakers are implementing healthcare reform, it is crucial to focus on patient-centered care and the promise it holds to improve both quality and affordability.

Christine Cassel is President and CEO of the American Board of Internal Medicine.

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  • Primary Care Internist

    I have heard this term and read such explanations as above so many times, and for the life of me, i still don’t quite understand what it means!
    can someone help me please?

  • http://wellescent.com/health_blog/is_patient_centered_medicine_bad_for_overall_health_care_quality Wellescent Health Care Blog

    While I am certainly a fan of patient-centered medical care, the results from the CommonWealth Fund study report don’t necessarily support patient-centered care as the most effective means to achieve health reform. The study does indicate that the current US system minus any recent changes from health reform is the worst of the seven, but the value of “Patient Centered Care” seemed to have an inverse relationship to the overall quality of care provided in the health care systems studied.

  • Max

    Dr. Berwick also stated:

    “decision is not whether or not we will ration care — the decision is whether we will ration with our eyes open. And right now, we are doing it blindly.”

    How is rationing ‘Patient-Centered’. What patient who is the center of his/her own health care wants their care rationed. It is an oxymoron. Rationing is not patient-centered. It is societal-centered.

  • http://skepticalscalpel.blogspot.com/ Skeptical Scalpel

    I share the views of my esteemed colleague, Primary Care Internist. What does “patient-centered care” mean? What were we doing with patients before “patient-centered care?” What term would we assign to the pre-”patient-centered care” era? What was it centered on, if not the patients? While we’re at it, someone define “medical home” for me too. Is there a medical garage or a medical garden as well?

  • DrB

    personally I think the AAFP, ABIM, and ACP should abandon the whole “patient centered care/ Medical home” charade. It is simply another “gatekeeper” system. when is primary care going to learn that:

    1. wonderful Medical Homes sound great.. but will only work if someone pays for them. gee…. still havent seen anyone talking about increasing reimbursement to primary care to pay for this.

    2. What patients want and crave (as evidenced by the growth of Direct pay models of care.) is TIME and a doctor to be their advocate.

    Patients dont care that they are getting a nutritionist and therapist and 7 other people seeing them with each visit.
    They want time with their doctor.

    Primary care NEEDS to focus on doing what we do best. Being our patients confidant and advocates through an insanely complicated and screwed up medical system.

    the only system that will bring down cost, improve medical care, and improve patient satisfaction is a system that will pay for and support primary care to return to that role.
    Be our patients advocates.

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