Managing Patient-Centered Care

Outcomes Look at patient-centered care and the impact on health care delivery systems. Analyze the implications of are planning, clinical reasoning and judgment, and patient/family education. Apply Health promotion, disease and illness prevention to nursing management.

IOM Patient-Centered Care is described as: “identify, respect, and care about patients’ differences, values, preferences and expressed needs; relieve pain and suffering; coordinate continuous care; listen to, clearly inform, communicate with, and educate patients; share decision-making and management; and continuously advocate disease prevention, wellness, and promotion of healthy lifestyles, including a focus on population health”. (2001)

What this means….. Share power and responsibility with patients and caregivers. Communicate openly. Consider the patient’s individuality, emotional needs, values, and life issues. Enhance prevention and health promotion. Book lists in detail the role of management and patient- centered care. (p )

Care is Centered Around the Patient….

Involve the Patient Clinical reasoning – assess the patient’s needs and or issues, analyze the data, and identify the problems within content of the patient’s environment. Clinical judgment – apply, analyze, and synthesize knowledge considering the patient context. “Decision Making”

Health Promotion Screening – labs and physical exam, Hx, risks Counseling – explaining the risk factors and health. Immunizations and chemoprophylaxis – modify lifestyles and make choices to improve their health and quality of life.

Illness Prevention Primary – prenatal clinics, stress management, AIDS prevention education, seat belt safety=before anything happens. Secondary – early diagnosis and treatment of s/s, mammograms, parent education, screening of diabetes. Tertiary – rehabitation, decrease disability, chemo

The Patient Comes First Case Study p. 221

Chronic Illness Disease that last more than 3 months Common chronic diseases include arthritis, asthma, cancer, COPD, diabetes and HIV/AIDS. In 2002 Chronic illnesses caused about 70% of deaths in the U.S. with such conditions as heart disease, cancers, stroke, chronic respiratory diseases, diabetes, Alzheimer’s disease and kidney diseases – 2/3 of the U.S. had a chronic illness Costing 1.6 trillion in medical costs

Chronic Illness

Chronic Illness Care Model Patient Safety = in the Health System Cultural Competency = Delivery System Care coordination = Health System & Clinical Information System Community Policies = Community resources and policies Case Management = in the Delivery System (Wagner, 1998, p. 222)

Disease Management Service methods used by third-party payers to control costs. Focus is on the whole person with a specific disease or illness, like diabetes or CHF. Improves patient outcomes. Encourages self-management, b/s or daily wts. Of CHF patients

Disease management Controls costs. Supports preventive care, keeps the patients out of the hospital. Increases compliance.

Tools to Manage Care Clinical Pathways – guidelines, timelines and practice guidelines for treatment, like DRGs. Have evolved over time. Now Called CareMaps, case management plans, integrated plans, etc. Focus is on admission to discharge.

Practice Guidelines Used by Managed Care Organizations. Reduce health care costs. Improve the quality of care. Ensures consistency of care. Provides performance data, especially now with pay-for- performance. Complies with accreditation and regulatory requirements.