What does it mean to deliver patient centered care? I know many of us have seen the NCQA checklist of items we need to mark in order to achieve PCMH recognition (Patient Center Medical Home). But what does it mean in our day to day work to put the patient at the center of the health care experience? From talking to our staff and clinical leaders, I have outlined what appears to be the key components of our mission to deliver patient centered care.
Engage and empower patients to own their health. Our health care system does not empower people to take control of their care. The system is complex and very difficult to navigate. We use clinical words that patients don’t understand. Engaging patients means using real language to explain their condition and their treatment. It means helping them navigate through the healthcare system. It means talking to them about the importance of preventive care as well as “sick” care. Most importantly, patient engagement happens when we build real relationships with our patients. Engage and empower patients to own the
Deliver care that is evidenced based. Now, evidenced based care is not static. It is based on evidence and as scientists and researchers collect more evidence, care delivery could and should change. A good example is cervical cancer screening. In 2012, the recommendation changed from 1 year to 3 years. Many women were confused by this change and wanted to be screened every year, but in a patient centered medical home setting, it is our job to explain why we only screen every three years. That means that our clinical staff must be up to date on the standard of care for the services we provide.
Manage populations of patients. It seems like a contradiction to say we are patient centered and we also seek to manage populations of patients, but one of the key components of patient centered care is that we assign patients to one clinical team, who monitors the health outcomes of their empaneled patients. So, we look at how many children have their immunizations by two years old. We look at how many patients are controlling their diabetes or blood pressure. We look at how many children have sealants on their first molars. We look at how many patients have the medication they need to control their asthma. This is population management and this is how we improve the health of communities.
Be accessible: It is critical that we are available when our patients need to see or talk to us. That is why we have same day appointments for both chronic visits and acute visits. That is why we have expanded hours at all our sites. That is why we open the dental clinic at 7 am, because parents want to bring their children to the dentist before school starts. That is why we have 24/7/365 on call coverage and that is why we discount our fees, labs that are very affordable, discounted and free medication, transportation assistance, etc.. Because it is critical that we are accessible to our patients and our communities.
Deliver team based care: There is no way that a physician and a nurse or even a dentist and dental hygienist can deliver care using the patient centered model. They would burn out in a couple of weeks. So patient centered care requires we use team based care and that each member of the team is working at the top of their licensure or certification. In Medical, we have the doctor or nurse practitioner, the nurses, the care coordinators, case managers and community health workers, the behavioral health consultants, the dietician and the patient service representative. In dental, we have the dentist, the dental hygienist, the dental assistants, the care coordinator and the patient service representatives. Each person has an important job to do in relationship to the patient and each person must communicate with the entire team about any issues associated with the patient.
Cost effective care: Patient centered care takes into consideration the cost of services to patients regardless of insurance status. We ask the question of whether it is appropriate to do an x-ray instead of a cat scan. We determine the most clinically and cost effective medications for our patients. We help patients understand how small behavioral changes will have a big impact on their health. For example, quitting smoking will lower your blood pressure and heart rate almost immediately. Your risk of a heart attack declines within 24 hours. Helping a pregnant woman access dental care means that the chance of her transmitting the bacterial that causes cavities to her child is reduced and her baby has a greater chance of being cavity free.
At Katy Trail Community Health, the patient comes first, and our providers and employees have the daunting and all important task of helping patients improve their health. We believe the patient centered model delivers results for our patients, so let’s start 2018 with a renewed dedication to our patients and our communities by focusing on patient centered care.