Department of Population Health, NYU Grossman School of Medicine, 227 E 30th St, New York, NY 10016. Email:
Am J Manag Care. 2021 May 1;27(5):e141-e144. doi: 10.37765/ajmc.2021.88635.
Patient-centered care, defined as "providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions," is advocated by clinicians and professional organizations and is part of a composite criterion for augmented reimbursement for various health care settings, including patient-centered medical homes. Despite general agreement that patient-centered care is a good idea and worthy of incentivization, patient-centered care is difficult to assess accurately, scalably, and feasibly. In this commentary, we suggest that assessment of patient-centered care may be improved by identifying circumstances that indicate its probable absence-in particular, by flagging probable discordance between a patient's preferences and their treatment care plan. One potential marker of this discordance is persistent lack of control of a comorbid condition that is easily controllable by existing therapies and where existing therapies are sufficiently diverse to be compatible with a wide range of patient preferences (eg, stage 1 hypertension, type 2 diabetes with glycated hemoglobin < 8.5%). We outline how this approach may be tested, validated, and harmonized with existing quality improvement activities.
以患者为中心的护理，定义为“提供尊重和响应个体患者偏好、需求和价值观的护理，并确保患者价值观指导所有临床决策”，受到临床医生和专业组织的倡导，是各种医疗保健环境（包括以患者为中心的医疗之家）增加报销的综合标准的一部分。尽管普遍认为以患者为中心的护理是一个好主意，值得激励，但以患者为中心的护理很难准确、可扩展和可行地进行评估。在这篇评论中，我们建议通过确定可能表明其缺失的情况（特别是通过标记患者偏好与其治疗护理计划之间可能存在的差异），可以改善对以患者为中心的护理的评估。这种差异的一个潜在标志物是，一种易于通过现有治疗方法控制的合并症持续缺乏控制，并且现有治疗方法足够多样化，可以与广泛的患者偏好兼容（例如，1 期高血压，糖化血红蛋白<8.5%的 2 型糖尿病）。我们概述了如何测试、验证和协调这种方法与现有的质量改进活动。
