The largest U.S. health insurance provider, the Centers for Medicare and Medicaid Services (CMS), has set a multiple aim: better care for patients, better health for communities, and lower costs. At the same time, major efforts have been released to make healthcare more patient-centered, defined as “respectful of and aware of individual patient choices, needs, and principles, and ensuring that individual principles guide all clinical choices.”Attention to patient-centered actions and results will be particularly important as CMS moves increasingly to link medical healthcare providers’ compensation to their performance on selected actions.
So far, tests of quality of patient care and wellness results have not incorporated patient-centeredness. Rather, amount of quality has resolved preventive and disease-specific wellness care processes (e.g., smoking-cessation guidance and start of appropriate medications after myocardial infarction). Similarly, results measurement has focused on condition-specific signs, both short-term (e.g., glycated hemoglobin levels and high blood pressure control) and longer-term (e.g., disease-free survival), as well as overall death rate.
Though these process and results measures work well for relatively healthy sufferers with single illnesses, they may be unsuitable for sufferers with several circumstances, serious impairment, or short life expectancy. For such sufferers, the overall quality of health care is determined by more than just disease-specific health care procedures. Furthermore, disease-specific results may not effectively indicate treatment effects in sufferers with several coexisting illnesses. Adopting of more worldwide results, such as efficient position, would not ensure patient-centeredness unless they were regarded within the perspective of individual patients’ objectives and choices in the face of trade-offs.
Perhaps the most important hurdle to goal-oriented patient care is that remedies are greatly based in a disease-outcome–based model. Rather than asking what sufferers want, the culture has respected handling each condition as well as possible according to recommendations and inhabitants’ goals.
Ultimately, good remedies are about doing right for the affected person. For sufferers with several serious illnesses, serious impairment, or limited life expectancy, any bookkeeping of how well we’re following in providing health care must above all consider patients’ recommended results.