2011, 2012; Sepucha et al., 2010). These patients also reported that their clinicians stressed the benefits of interventions more than they discussed the risks, and asked patients about their preferences only half of the time (Zikmund-Fisher et al., 2010). Because modern health care often offers multiple interventions for a given condition, each with its own benefits, side effects, and costs, identifying the most valuable intervention for each patient requires both that patients be well informed about the options and that clinicians be aware of their patients’ individual circumstances, preferences, and needs.
The lack of patient focus in the health care system also is evident in patient transitions between care settings. Patients often report that care transitions, such as being discharged from the hospital, are abrupt. Patients often receive little information about what the next steps are in their care, when they can resume activities, what side effects or complications they should monitor, or whom they can approach with questions about their recovery. In other cases, patients receive too much information at the time of discharge, stressing their ability to remember and apply this information over the transition period. As a result of poor transitions, almost one-fifth of hospitalized Medicare patients are rehospitalized within 30 days, often without seeing their primary care provider in the interim (Jencks et al., 2009). Communications between primary care practitioners and specialists often lack critical information, and hospitals often either do not notify primary care practitioners when their patients are discharged or relay insufficient information (Bodenheimer, 2008). Transitions may be even less effective and more complex when patients’ needs extend beyond traditional health care to include a broader array of health and human services, such as long-term care; mental health and substance use care; and social, economic, and community services related to wellness and healthy lifestyles.
Foundational Elements of Patient-Centered Care
Part of the challenge is that the notion of patient-centeredness simply is not embedded in the care culture and often feels foreign, even disruptive, to clinicians unfamiliar with the concept (Berwick, 2009). Because investments in moving toward patient-centered care currently are being made on a large scale, developing a working definition of patient- or person-centered care is a matter of some urgency, especially given that patient perspectives will soon be factored into Medicare value-based payments to hospitals.1 Absent this framework, it will be impossible to assess the progress of initiatives toward the goal of improving patient focus. The difficulty is that
1Patient Protection and Affordable Care Act, Public Law 111-148, 111th Congress (March 23, 2010).