Patient-centered outcomes are results of health care that can be obtained from a healthcare professional's ability to care for their patients and their patient's families in ways that are meaningful, valuable and helpful to the patient. Patient-centered outcomes focus attention on a patient's beliefs, opinions, and needs in conjunction with a physician's medical expertise and assessment. [1] In the United States, the growth of the healthcare industry has put pressure on providers to see more patients in less time, fill out paperwork in a timely manner, and stay current on the ever-changing medical advancements that occur daily. This increased pressure on healthcare workers has put stress on the provider-patient relationship. [2] The Patient-Centered Outcomes Research Institute (PCORI) is a United States Government funded research institute that funds studies that compare healthcare options to find out what options and situations work best for patients of different circumstances. PCORI uses their research to increase the quality of healthcare and push the healthcare system towards a more patient-centered approach. [3] The Beryl Institute, a non-profit institute dedicated to the improvement of patient experience through Evidence-based research, released data that found that over 90% of patients believe patient-centered outcomes to be "extremely important" to their healthcare experience. [4] Individuals that participated in this study by the Beryl Institute claimed that the aspects of healthcare that they see as most influential to their healthcare experience include effective communication, pain management, a clear and well-explained plan of care and a clean and comfortable environment. [4] In addition to this data, women were found to have the largest issues with lack of patient-centered care, reporting higher rates of pain and less empathy than men. [5]
In the 19th century, the United States Healthcare System began with hospitals offering services to individuals on a fee for service basis, allowing providers to price discriminate based on the health of their patients. [6] With the growth of the American healthcare system after the early 19th century, patient-centered outcomes began to become more of a focus within the healthcare community. In 1978, The Declaration of Alma-Alta was created as the first international declaration of primary healthcare's role in promoting the health of all people. [7] Later, in 2001, the Institute for Healthcare Improvement released its six aims for changing healthcare, citing patient-centered healthcare as its third aim. [7]
Following the publishing of the six aims, President Barack Obama signed the Patient Protection and Affordable Care Act into law. The Patient Protection and Affordable Care Act had three primary goals, to make health insurance affordable and available to more people, to expand the Medicaid to cover more individuals, and to support innovative medical care delivery methods that would lower the costs of health care. [8] With these changes, there was a significant increase in the popularity of the push towards patient-centered healthcare. The Affordable Care Act's federal incentive programs put emphasis on value-based reimbursement. These programs, along with the basic increase in volume of patients that entered the healthcare system under the ACA, put an increased emphasis on patient-centered outcomes and consumer experiences. [9]
In 2014, the Institute Of Medicine (IOM) published six dimensions of patient-centered healthcare that they deemed as essential in producing quality healthcare. These six dimensions are:
The overall goal of a patient-centered outcome approach to healthcare is the focus on an individual's specific healthcare needs taking into account the patient's own goals in treatment alongside the provider's best clinical expertise in the topic as a medical professional. While it is important to have members of a multidisciplinary healthcare team that have the best training and knowledge caring for the patient, it is also essential that the patient themselves to actively communicate and be vocal about their values and concerns. [11] Healthcare professionals should be using language that the patient can understand and should educate and inform their patients on all decisions made concerning their health. Additionally, researchers seeking to provide evidence to positively guide effective patient-centered decision-making need to ensure standards to prevent missing data that can result in challenges to the integrity of the studies that produce the guidelines themselves. [12]
The United States pays more in healthcare expenditure per capita than any other country. Healthcare expenditures the United States accounts for approximately 16% of the country's gross domestic product and per capita spending on healthcare is more than twice that of other developed nations. [13] Given these statistics, healthcare in the United States is no better than in other countries, with the more than 50 million people uninsured and astronomical healthcare prices and expenditures. [14] Much of what accounts for the high expenditures is the fact that a large percentage of money going into healthcare is put towards wasteful or unnecessary expenses. Examples of these non-economical expenditures include excessive administrative costs, fraud, and abuse within the healthcare system (both among providers and patients), and misallocated treatments and procedures. [13] This misuse of funds jeopardizes providers to offer the best services to their patients and leaves reduced funds for research into developing new diagnostic and treatment technologies. Abuse of healthcare funds in the United States is a barrier that patient-centered outcomes face as it diverts funds from healthcare professionals who are dedicated to promoting the idea of patient-centered healthcare.
Health economics is a branch of economics concerned with issues related to efficiency, effectiveness, value and behavior in the production and consumption of health and healthcare. Health economics is important in determining how to improve health outcomes and lifestyle patterns through interactions between individuals, healthcare providers and clinical settings. In broad terms, health economists study the functioning of healthcare systems and health-affecting behaviors such as smoking, diabetes, and obesity.
Primary care is the day-to-day healthcare given by a health care provider. Typically this provider acts as the first contact and principal point of continuing care for patients within a healthcare system, and coordinates other specialist care that the patient may need. Patients commonly receive primary care from professionals such as a primary care physician, a physician assistant,a Physical Therapist, or a nurse practitioner. In some localities, such a professional may be a registered nurse, a pharmacist, a clinical officer, or an Ayurvedic or other traditional medicine professional. Depending on the nature of the health condition, patients may then be referred for secondary or tertiary care.
Healthcare in Canada is delivered through the provincial and territorial systems of publicly funded health care, informally called Medicare. It is guided by the provisions of the Canada Health Act of 1984, and is universal. The 2002 Royal Commission, known as the Romanow Report, revealed that Canadians consider universal access to publicly funded health services as a "fundamental value that ensures national health care insurance for everyone wherever they live in the country."
Community health refers to simple health services that are delivered by laymen outside hospitals and clinics. Community health is also the subset of public health that is taught to and practiced by clinicians. Community health volunteers and community health workers work with primary care providers to facilitate entry into, exit from and utilization of the formal health system by community members.
Health equity arises from access to the social determinants of health, specifically from wealth, power and prestige. Individuals who have consistently been deprived of these three determinants are significantly disadvantaged from health inequities, and face worse health outcomes than those who are able to access certain resources. It is not equity to simply provide every individual with the same resources; that would be equality. In order to achieve health equity, resources must be allocated based on an individual need-based principle.
In the healthcare industry, pay for performance (P4P), also known as "value-based purchasing", is a payment model that offers financial incentives to physicians, hospitals, medical groups, and other healthcare providers for meeting certain performance measures. Clinical outcomes, such as longer survival, are difficult to measure, so pay for performance systems usually evaluate process quality and efficiency, such as measuring blood pressure, lowering blood pressure, or counseling patients to stop smoking. This model also penalizes health care providers for poor outcomes, medical errors, or increased costs. Integrated delivery systems where insurers and providers share in the cost are intended to help align incentives for value-based care.
Patient safety is a discipline that emphasizes safety in health care through the prevention, reduction, reporting and analysis of error and other types of unnecessary harm that often lead to adverse patient events. The frequency and magnitude of avoidable adverse events, often known as patient safety incidents, experienced by patients was not well known until the 1990s, when multiple countries reported significant numbers of patients harmed and killed by medical errors. Recognizing that healthcare errors impact 1 in every 10 patients around the world, the World Health Organization (WHO) calls patient safety an endemic concern. Indeed, patient safety has emerged as a distinct healthcare discipline supported by an immature yet developing scientific framework. There is a significant transdisciplinary body of theoretical and research literature that informs the science of patient safety with mobile health apps being a growing area of research.
A Patient Safety Organization (PSO) is a group, institution, or association that improves medical care by reducing medical errors. Common functions of patient safety organizations are data collection and analysis, reporting, education, funding, and advocacy. A PSO differs from a Federally designed Patient Safety Organization (PSO), which provides health care providers in the U.S. privilege and confidentiality protections for efforts to improve patient safety and the quality of patient care delivery
Limited English proficiency (LEP) is a term used in the United States that refers to a person who is not fluent in the English language, often because it is not their native language. Both LEP and English-language learner (ELL) are terms used by the Office for Civil Rights, a sub-agency of the U.S. Department of Education.
Healthcare reform in the United States has a long history. Reforms have often been proposed but have rarely been accomplished. In 2010, landmark reform was passed through two federal statutes: the Patient Protection and Affordable Care Act (PPACA), signed March 23, 2010, and the Health Care and Education Reconciliation Act of 2010, which amended the PPACA and became law on March 30, 2010.
In economics, supplier induced demand (SID) may occur when asymmetry of information exists between supplier and consumer. The supplier can use superior information to encourage an individual to demand a greater quantity of the good or service they supply than the Pareto efficient level, should asymmetric information not exist. The result of this is a welfare loss.
Comparative effectiveness research (CER) is the direct comparison of existing health care interventions to determine which work best for which patients and which pose the greatest benefits and harms. The core question of comparative effectiveness research is which treatment works best, for whom, and under what circumstances. Engaging various stakeholders in this process, while difficult, makes research more applicable through providing information that improves patient decision making.
Patient participation is a trend that arose in answer to medical paternalism. Informed consent is a process where patients make decisions informed by the advice of medical professionals.
Healthcare in the United States is subject to far higher levels of spending than any other nation, measured both in per capita spending and as a percentage of GDP. Despite this, the country has significantly worse healthcare outcomes when compared to peer nations. The US is the only developed nation without a system of universal healthcare, with a large proportion of its population not carrying health insurance, a substantial factor in the country's excess mortality during the COVID-19 pandemic.
An accountable care organization (ACO) is a healthcare organization that ties provider reimbursements to quality metrics and reductions in the cost of care. ACOs in the United States are formed from a group of coordinated health-care practitioners. They use alternative payment models, normally, capitation. The organization is accountable to patients and third-party payers for the quality, appropriateness and efficiency of the health care provided. According to the Centers for Medicare and Medicaid Services, an ACO is "an organization of health care practitioners that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it".
In United States healthcare, service excellence is the ability of the provider to consistently meet and manage patient expectations. Clinical excellence must be the priority for any health care system. However, the best healthcare systems combine professional (clinical) service excellence with outstanding personal service. Although health care in the United States is touted as the “world’s largest service industry,” the quality of the service is infrequently discussed in medical literature. Thus, many questions regarding service excellence in healthcare largely remain unanswered.
India has a multi-payer universal health care model that is paid for by a combination of public and private health insurance funds along with the element of almost entirely tax-funded public hospitals. The public hospital system is essentially free for all Indian residents except for small, often symbolic co-payments in some services.
Health care quality is a level of value provided by any health care resource, as determined by some measurement. As with quality in other fields, it is an assessment of whether something is good enough and whether it is suitable for its purpose. The goal of health care is to provide medical resources of high quality to all who need them; that is, to ensure good quality of life, cure illnesses when possible, to extend life expectancy, and so on. Researchers use a variety of quality measures to attempt to determine health care quality, including counts of a therapy's reduction or lessening of diseases identified by medical diagnosis, a decrease in the number of risk factors which people have following preventive care, or a survey of health indicators in a population who are accessing certain kinds of care.
Throughout the United States, many rural communities are faced with severe healthcare workforce shortage issues. These regions often consist of a larger percentage of medically underserved individuals, in conjunction with fewer physicians, nurses, and other healthcare workers. The shortage of healthcare workers negatively impacts the quality of medical care due to decreased access to health services as well as an increase in workload placed on providers. Healthcare systems in rural communities generally have fewer personnel and infrastructure, creating substantial healthcare disparities among the United States population. Rural communities tend to have a higher incidence of chronic diseases, infant and maternal morbidity, and occupational injuries. These communities also consist of individuals who tend to be older and have a lower socioeconomic status, which directly relates to the high rate of uninsured individuals. Ethnic minorities are also increasing in number throughout rural areas, further adding to the size of healthcare disparities.
Cultural competence in healthcare refers to the ability for healthcare professionals to demonstrate cultural competence toward patients with diverse values, beliefs, and feelings. This process includes consideration of the individual social, cultural, and psychological needs of patients for effective cross-cultural communication with their health care providers. The goal of cultural competence in health care is to reduce health disparities and to provide optimal care to patients regardless of their race, gender, ethnic background, native languages spoken, and religious or cultural beliefs. Cultural competency training is important in health care fields where human interaction is common, including medicine, nursing, allied health, mental health, social work, pharmacy, oral health, and public health fields.
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