Category Archives: Patient-Centered Care

Mar 14 2014
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‘Teamwork Works’: Lessons Learned From the Front Line of Team-Based Care

As the patient-centered medical home (PCMH) has emerged as a model for providing effective team-based care that can help offset the impending primary care provider shortage, so, too, is there a growing need for educational strategies that promote interprofessional collaboration. A short report published online by the Journal of Interprofessional Care describes the strategies in place at the VA Connecticut Healthcare System Center of Excellence in Primary Care Education (CoEPCE) and indicates promising results in just one year: doubled productivity in patient care delivered by faculty providers, and a marked increase in same-day clinic access for patients receiving care from an interprofessional team.

The Connecticut CoEPCE, like four other program sites funded through the U.S. Department of Veterans Affairs Office of Academic Affiliations, builds on the VA’s system-wide PCMH model, known as Patient Aligned Care Teams (PACT). It seeks to develop exportable models of interprofessional education and patient care, according to the report, “Moving From Silos to Teamwork: Integration of Interprofessional Trainees Into a Medical Home Model.” The CoEPCE sites share four core curricular domains—shared decision-making, sustained relationships, interprofessional collaboration, and performance improvement—and the Connecticut center groups together physician, nurse practitioner (NP), pharmacy, and health psychology trainees.

The trainees divide their time evenly between interactive educational sessions and caring for patients, guided by faculty who provide supervision, mentorship, and collaborative shared care. Additionally, the Connecticut center incorporates a one-year post-master’s adult NP interprofessional clinical fellowship, to further enhance clinical proficiency and teamwork experience for NPs.

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Nov 26 2013
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Empathy and Appreciation for the Impact of the Social Determinants of Health

Gretchen Hammer, MPH, is executive director of the Colorado Coalition for the Medically Underserved. She works with local and state health care leaders and policy-makers to improve Colorado’s health care system.

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Healing is both an art and a science. On one hand, clinicians are intensely driven by the quantifiable, the measurable, and the evidence-based algorithms that lead to accurate diagnosis and treatment as well as allow us to develop new innovations in medicine. However, healing is also an art. Patients are not just a collection of systems that can be separated out and managed in isolation of the whole patient. Each patient and their family has a unique set of values, life experiences, and resources that influence their health and ability to heal. Recognizing the wholeness and uniqueness of each patient is where the art of healing begins.

Empathy is defined as “the ability to understand and share the feelings of another.” It takes presence of mind and time to be empathetic. For clinicians, finding the balance between the necessary detachment to allow for good clinical decision making and empathy can challenging.  This balance can be particularly difficult for students and new clinicians.

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Sep 27 2013
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Professional Interpreters are Costly, But Crucial

Lisa Ross DeCamp, MD, MSPH, is an alumna of the Robert Wood Johnson Foundation Clinical Scholars program. She is an assistant professor of pediatrics at Johns Hopkins University School of Medicine and a researcher with the Center for Child and Community Health Research.

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Good communication is critical for development of an effective partnership between patient and provider.  However, for the more than 25 million people in the United States who report speaking English less than very well and are classified as having limited English proficiency (LEP), access to the most basic aspect of communication—a common language with the provider—may be limited.

It is easy to imagine how language barriers may compromise the quality and safety of health care. Research consistently demonstrates that physicians falter in many aspects of communication, compromising health care quality and lowering patient satisfaction even when they speak the same language.  Quality and satisfaction gaps stemming from poor communication are only magnified when a language barrier is present. Health care safety requires understanding instructions, again an impossible task if the patient and provider do not share a common language. 

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Sep 6 2013
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Is the Brain Ready for Personalized Medicine? Studies Suggest Not Quite Yet.

Jason Karlawish, MD, is a professor of medicine, medical ethics and health policy at the University of Pennsylvania and the director of Penn’s Neurodegenerative Disease Ethics and Policy Program. He is the recipient of a Robert Wood Johnson Foundation Investigator Award in Health Policy Research.

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“Prescribe the right drug to the right patient at the right time” is not a new medical practice, but when a biomarker—that is, a measure of disease pathophysiology—or a gene makes this decision, that is a radically new medical practice. The promise of personalized medicine is that biomarker and gene driven algorithms will do much of the work of medicine. By predicting patients’ future health and the outcomes of an intervention, they will guide what doctors recommend to their patients. Like the theory of evidence-based medicine, personalized medicine promises a more objective, efficient and precise medical practice.

To date, personalized medicine has largely flourished “below the neck,” that is, in the care of patients with common medical diseases, particularly cancer and cardiovascular disease. In the last two decades though, the National Institutes of Health, the pharmaceutical industry, and researchers have invested substantial time and money in research such as the Alzheimer’s Disease Neuroimaging Initiative (called “ADNI”) dedicated to discovering and validating the biomarkers and genes that predict whether a brain will fail. This research is beginning to reshape how we talk about the diagnosis and treatment of the aging brain, an organ that is more and more, like hearts and bones, regarded as an organ “at risk.” As a result, clinicians, ethicists, and health care policy-makers are beginning to ask how we should practice personalized medicine for the seemingly healthy brain that is at risk for neurodegenerative dementias such as Alzheimer’s, Parkinson’s, Lewy Body Disease and frontotemporal lobar degeneration.

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Aug 5 2013
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Ode to My Favorite Gadget: A Heart ECG at Your Fingertips!

Kathleen Hickey, EdD, FNP-BC, ANP-BC, FAAN, is a nurse practitioner in cardiac electrophysiology, an assistant professor at the Columbia University School of Nursing, and an alumna of the Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholars program. Hickey is president of the International Society of Nurses in Genetics.

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As a cardiovascular nurse practitioner, there have been many instances when a patient has reported an intermittent and sporadic racing of the heart, chest pressure or other vague symptom. If I had only an ECG (electrocardiogram) when that was happening, I thought to myself on many occasions.

But as most practitioners know, in the real world such episodes rarely occur while the patient is right in front of them. Rather, symptoms occur when the patient is at home, at work, has just left the provider’s office, or is on vacation!

The widespread use of smart phones has resulted in a plethora of gadgets, gizmos, and associated health care applications—but one I can’t live without is the AliveCor heart recorder and application that is now compatible with the iPhone.

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Jul 25 2013
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Today: Twitter Chat on How to Be an Engaged Patient

Join U.S. News & World Report this afternoon for a Twitter chat about how patients in hospitals can take ownership of their care and become actively engaged and informed about their treatment.

Among the experts participating in the chat is Marianne Weiss, DNSc, RN, a grantee of the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative. Weiss is a researcher focusing on improving patients’ experience with hospital discharge and the role nurses play in discharge preparation and the discharge transition. Her research on patient perceptions of discharge teaching, readiness for discharge, and coping difficulty at home following hospital discharge have highlighted the importance of inclusion of patient voice to improve discharge experiences.

She will join representatives from the National Patient Safety Foundation, the Patient Advocate Foundation, and CNN’s Elizabeth Cohen, among others, for the chat.

Date: Thursday, July 25
Time: 2 p.m. to 3 p.m. ET
Hashtag: #PatientChat
Moderator: @USNewsHealth
Experts: @INQRIprogram, @RWJF_HumanCap, @theNPSF, @NPAF_tweets, @TrishaTorrey, @tedeytan, @elizcohencnn

Learn more about the chat.

Jun 6 2013
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Human Capital News Roundup: Nurse PhD scientists, shared decision making, mammogram guidelines, and more.

Around the country, print, broadcast and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni and grantees. Some recent examples:

RWJF this week launched the Future of Nursing Scholars program, a $20-million initiative to support some of the country’s best and brightest nurses as they pursue PhDs. The program will provide scholarships, stipends, mentoring, leadership development, and dedicated post-doctoral research support, the Philadelphia Business Journal reports. John Lumpkin, MD, MPH, RWJF senior vice president and director of the Health Care Group, said: “The PhD-prepared nurses the Future of Nursing Scholars program supports will help identify solutions to the country’s most pressing health problems, and educate thousands of nurses over the course of their careers.” Read more about the program.

Patients who are involved in their care spend more time in the hospital and increase the cost of their hospital stays, compared to patients who delegate medical decisions to their doctors, according to a study led by David Meltzer, MD, PhD. Meltzer is an alumnus of the RWJF Generalist Physician Faculty Scholars program, and recipient of an RWJF Investigator Award in Health Policy Research. Among the outlets to report on the findings: HealthDay, Time Magazine’s Healthland blog, United Press International, and Modern Healthcare.

A study led by RWJF Nurse Faculty Scholar Jodi Ford, PhD, RN, finds that having lived in a poor neighborhood as a teen—even if the teen’s family wasn’t poor—increases the risk of having chlamydia in young adulthood by 25 percent, compared to teenagers living in wealthier settings, Science Daily reports.

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Apr 8 2013
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Patient-Centered Medicine and Health Reform

Benjamin Roman, MD, is a Robert Wood Johnson Foundation (RWJF) Clinical Scholar in residence at the University of Pennsylvania and a senior fellow at the Leonard Davis Institute of Health Economics. This is part of a series of essays, reprinted from the Leonard Davis Institute of Health Economics’ eMagazine, in which scholars who attended the recent AcademyHealth National Health Policy Conference reflect on the experience.

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The term “patient-centered" has become something of a mantra in the nation’s current health reform efforts. There’s widespread agreement—at least in theory—that putting the patient at the center of everything is important but, as demonstrated in discussions at the recent AcademyHealth National Health Policy Conference, there is no exact blueprint for how to accomplish that.

Patient-centeredness means many things to many different people, but at its core are issues of shared decision-making and balancing how much the patient should really be in the driver’s seat. Patients want more information, but too much is overwhelming. They want to be nudged to do the right thing for their health, but not nagged. They want to choose health care wisely, but they don’t necessarily want less. Doctors want to involve patients in decision-making but don’t know how, or what evidence to use for the discussion.

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Apr 1 2013
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Shedding Light on OpenNotes

Tom Delbanco, MD, MACP, is Koplow-Tullis Professor of Medicine at Harvard Medical School, Beth Israel Deaconess Medical Center. He is an alumnus of the Robert Wood Johnson Foundation Health Policy Fellows program.

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In a recent blog post, Anjali Gopalan, MD, a Robert Wood Johnson Foundation Clinical Scholar, weighed the pros and cons of OpenNotes—an effort to share clinicians’ notes with patients that is a stimulating collaboration among a large group of investigators, practitioners and patients in Boston; Danville, Pennsylvania; and Seattle.

Dr. Gopalan made a number of insightful observations that I’d like to comment on, but I need first to correct a fundamental misperception: OpenNotes is decidedly not a software program!!!

OpenNotes is an effort to convince patients, families, and clinicians to share openly any and, most often, all material that pertains to a patient’s care. The goal of such action is to improve communication between clinicians and patients, and to help patients engage more actively in managing their health and health care.

OpenNotes doesn’t depend on electronic health records or other software. Purely and simply, we are suggesting to patients that they routinely ask for a copy of their providers’ notes (to which they are legally entitled through HIPAA). And we are suggesting to clinicians that they routinely invite their patients to read them. Pull down the invisible firewall that we clinicians have long established, and the patient (and others whom he or she wishes to involve) can view the thinking that leads us to conclusions and recommendations.

To be sure, patient portals can facilitate sharing information with patients, and their future potential is enormous. But unblinding the story, the warp and woof of an individual’s experience that’s documented in clinicians’ notes, can also be done by low-tech means such as providing print copies of the notes at the end of a visit or later by mail.

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Mar 26 2013
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Weighing the Good and Bad of OpenNotes

Anjali Gopalan, MD, is a Robert Wood Johnson Foundation (RWJF) Clinical Scholar in residence at the University of Pennsylvania, and a senior fellow at the Leonard Davis Institute of Health Economics. This is part of a series of essays, reprinted from the Leonard Davis Institute of Health Economics’ eMagazine, in which scholars who attended the recent AcademyHealth National Health Policy Conference reflect on the experience.

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Propelled by a highly publicized study funded by a $1.4 million grant from the Robert Wood Johnson Foundation, OpenNotes software has created quite a stir in the world of health care reform since 2010. Its high-profile testing paralleled the rise of the Affordable Care Act and the new emphasis that law puts on the computerization of virtually every part of medicine, including the doctor-patient relationship itself.

OpenNotes is a digital tool with which a physician takes and stores the notes of every encounter with a patient. The new aspect of OpenNotes that has drawn so much attention in the press and professional venues like the AcademyHealth National Health Policy Conference is its ability to provide patients instant access to everything the doctor writes about them.

Subject of Much Debate

The question of how this new kind of doctor-patient information collaboration might ultimately affect either party remains the subject of much debate. The conference session that focused on it was entitled "Stirring It Up: Putting Patients in the Middle" and featured Tom Delbanco, MD, the Harvard Medical School professor who is leading the national OpenNotes development and implementation effort.

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