Bezold Clement
Institute for Alternative Futures, Alexandria, VA 22314, USA.
J Altern Complement Med. 2005;11 Suppl 1:S77-84. doi: 10.1089/acm.2005.11.s-77.
The U.S. health care system is transforming. It must. Patient-centered care (PCC) is a core quality that the system should include. This article presents the highlights of a project on the future of PCC created for the Picker Institute. As an example of futures work, this project developed four images or stories of what might happen, as well as a vision and audacious goals for what should happen to PCC. The first and most likely scenario is an increase in patient-centeredness as a function of current trends. However, in the second scenario, health care could become even more stressed and leave PCC behind as it seeks to lower cost without focusing on quality. The third scenario envisions more excellent systems that integrate PCC seamlessly into their work. The fourth scenario sees collaboration and shared responsibility, in association with advanced information tools, thereby enabling PCC to contribute to preventing illness and lowering health care costs. The scenarios indicate that the patient-centeredness of health care could improve slightly, stall, or advance significantly. The PCC Vision calls for each of us to be in charge of our health, and to get the care we need (not less and not more) in timely, effective, and personal ways consistent with our values. The audacious goals set an agenda with priorities from the PCC community. These include shared decision making by consumers, ensuring health care professionals are trained in supporting active patients, anticipating health and long-term care needs for individuals, adopting the Institute of Medicine's (IOM) simple rules for health care, and making the patient perspective a priority in policy and planning. Each of us and our organizations are confronted with the challenge of this vision and audacious goals. Health care professionals and provider systems, whether conventional or alternative in nature, face these issues. While complementary and alternative medicine (CAM) providers often get higher marks from consumers for their attention, many CAM modalities are largely provider-determined. Patient-centered care will require more empowerment and activation of patients and consumers.
美国医疗保健系统正在转型。它必须转型。以患者为中心的护理（PCC）是该系统应具备的核心品质。本文介绍了为皮克研究所开展的一个关于PCC未来的项目要点。作为未来研究工作的一个实例，该项目描绘了四种可能出现的情景或情况，以及PCC应如何发展的愿景和大胆目标。第一种也是最有可能出现的情景是，随着当前趋势的发展，以患者为中心的程度会有所提高。然而，在第二种情景中，医疗保健可能会面临更大压力，在寻求降低成本而不关注质量的过程中，将PCC抛在脑后。第三种情景设想了更卓越的系统，能够将PCC无缝融入其工作中。第四种情景则是通过先进的信息工具实现协作和共同责任，从而使PCC有助于预防疾病和降低医疗保健成本。这些情景表明，医疗保健的以患者为中心程度可能会略有提高、停滞不前或大幅推进。PCC愿景要求我们每个人都对自己的健康负责，并以符合我们价值观的及时、有效和个性化方式获得所需的护理（不多也不少）。大胆目标设定了一个议程，列出了PCC社区的优先事项。这些事项包括消费者共同决策、确保医护人员接受培训以支持积极参与的患者、预测个人的健康和长期护理需求、采用医学研究所（IOM）的医疗保健简单规则，以及在政策和规划中将患者视角作为优先事项。我们每个人以及我们的组织都面临着这一愿景和大胆目标带来的挑战。医疗保健专业人员和提供系统，无论其性质是传统的还是替代的，都面临这些问题。虽然补充和替代医学（CAM）提供者通常因其关注度而在消费者中获得更高评价，但许多CAM模式在很大程度上由提供者决定。以患者为中心的护理将需要患者和消费者更多的自主权和积极性。
