A Systems Approach to Patient-Centered Care

PROVIDING CARE CENTERED ON PATIENTS’ NEEDS AND expectations is a key attribute of quality care. Unfortunately, despite the intent and efforts of many to improve patient centeredness, the quality of patient-clinician relationships, patient access, and continuity of care appear to be worsening in the United States and lag behind other Organization for Economic Co-operation and Development (OECD) countries. Clinicians do not consistently address patients’ concerns, do not always assess patients’ beliefs and understanding of their illness, and often do not share management options with patients. Patients frequently fail to recall basic elements of their care plan. All this is occurring as care becomes increasingly complex and as more costs of care are borne directly by patients. In this Commentary, we propose 4 specific changes that should help the medical profession meet patients’ needs and expectations. These changes involve redesigning the systems of care that both evidence and practice suggest are more likely to succeed rather than relying on clinician rewards, feedback, or training alone. They are (1) improving access to and continuity with clinicians, (2) increasing patients’ participation in care by making it easier for patients to express their concerns and involving them more actively in the design of their care, (3) supporting patient self-management through systems that facilitate goal setting and that increase patient and family confidence in self-care, and (4) establishing more efficient and reliable mechanisms for coordinating care among settings. The evidence for most of these system changes is robust and supported by clinical trials that have demonstrated the desired outcomes. Some interventions have been widely implemented in practice and appear promising but have not been subject to clinical trials and require further evaluation. Consolidating these approaches into a coordinated series of practical system changes is the purpose of this Commentary. The magnitude of their combined effect is unknown but should be intensively studied. Although the proposed system changes could be applied to all patients, the chronic care model is an example of an evidence-based system approach that includes selfmanagement support and care coordination as key components.