Physical Address
304 North Cardinal St.
Dorchester Center, MA 02124
Patient-Centered Care in Perioperative Outcomes
Key points
-
Value in health care is defined as patient-centered outcomes (PCOs) relative to the cost of achieving those outcomes.
-
PCOs must consider the health trajectory well past discharge.
-
Patient outcomes include that there is concordance of the expectations of the planned procedure with patient preferences, goals, and values.
What Is Patient-Centered Care?
Patient-centered care requires that all disciplines involved in treating a specific surgical condition develop evidence-based collaborative care pathways with value-based metrics. The patient is at the center of the care, the patient's voice is an important part of the collaboration, and individual patient characteristics, both clinical and nonclinical, are accounted for. An effort is made to understand patient values and goals and to ensure that care aligns with these. Expectations and possible health trajectories are discussed realistically; evidence-based collaborative pathways are used to achieve these goals. Metrics are patient centered and continue long past discharge. Equity is ensured by including the impact of disparities, culture, language, access issues, health literacy, and disabilities when planning care pathways. Enhanced patient engagement is key.
High-value health care should ensure patient-centered care as well. Specific elements include institutional buy-in, metric shift, condition-specific metrics leading to multidisciplinary care pathways, and patient-centered care aligned with individual values and goals.
Institutional Buy-In
High-value, patient-centered care cannot be achieved without institutional alignment. The upper levels of the organization must value patient-centered outcomes (PCOs) and not just traditional metrics. Achieving buy-in from institutional leadership is often the most difficult step; however, clinicians without leadership support are unlikely to achieve desired goals. As payment models continue to transition from volume to value, the increasing focus on linking revenue to quality metrics may ease this transition. Unenlightened institutions may persist in old paradigms even in the setting of these transitions, which is likely to cause further disconnect between leadership and clinicians performing care.
Metric Shift
Traditional metrics have focused on the absence of negative outcomes or process metrics rather than positive long-term PCOs. Arbitrary definitions of “in-hospital,” “7-day,” and “30-day” morbidity and mortality as definitions of success completely neglect the patient's goals in having the surgery; the patient has a procedure to achieve some positive impact on health trajectory and does not count success as merely being alive and uninjured on day 30. Why have these metrics become so ubiquitous? They are easy to measure and offer some overall information that can be used for benchmarking. Measuring PCOs that are condition specific and incorporate patient values and goals is hard. Process metrics such as “turnover time” or “operating room utilization” may be useful for operations planning and do play a role in the cost denominator of the value equation, but they do not relate to patient-centered care or PCOs. Judging clinicians by their ability to achieve these process metrics and not by their ability to achieve condition-specific PCOs can increase the institutional disconnect and impede patient-centered care.
You're Reading a Preview
Become a Clinical Tree membership for Full access and enjoy Unlimited articles
If you are a member. Log in here
