Patient Centeredness, Cultural Competence and Healthcare Quality by ProQuest


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Patient Centeredness, Cultural Competence
and Healthcare Quality
Somnath Saha, MD, MPH; Mary Catherine Beach, MD, MPH; and Lisa A. Cooper, MD, MPH


  financial support: This study was supported by The Com-
                                                                                    ultural competence and patient centeredness are
  monwealth Fund, a New York City-based private, indepen-
                                                                                    approaches to enhancing healthcare delivery
  dent foundation. Dr. Saha was supported by an Advanced
                                                                                    that have been promoted extensively in recent
  Research Career Development Award from the Health Ser-
                                                                            years. As they have gained recognition and popularity,
  vices Research and Development Service of the Depart-
                                                                            however, considerable ambiguity has evolved in their
  ment of Veterans Affairs. Drs. Saha and Beach were sup-
                                                                            definition and use across settings. Proponents of patient
  ported by Generalist Physician Faculty Scholar Awards from
                                                                            centeredness speak of cultural competence as merely
  the Robert Wood Johnson Foundation. Dr. Cooper was sup-
                                                                            one aspect of patient-centered care, while proponents
  ported by the National Heart Lung and Blood Institute (grant
                                                                            of cultural competence often assert the converse. The
  #K24HL083113). The views expressed in this paper are those of
                                                                            purpose of this paper is to present and compare the ide-
  the authors and not necessarily those of The Commonwealth
                                                                            als of patient centeredness and cultural competence, to
  Fund, the Department of Veterans Affairs, the National Insti-
                                                                            define their similarities and differences, and to discuss
  tutes of Health or the Robert Wood Johnson Foundation.
                                                                            their implications for improving healthcare quality at
  Cultural competence and patient centeredness are                          the interpersonal and health system levels.
  approaches to improving healthcare quality that have
  been promoted extensively in recent years. In this paper, we              the evolutIon of PatIent
  explore the historical evolution of both cultural competence              centeredness
  and patient centeredness. In doing so, we demonstrate
  that early conceptual models of cultural competence and                   early conceptions of Patient
  patient centeredness focused on how healthcare providers                  centeredness
  and patients might interact at the interpersonal level and                    Originally coined by Balint in 1969 to express the
  that later conceptual models were expanded to consider                    belief that each patient “has to be understood as a unique
  how patients might be treated by the healthcare system                    human-being,”1 patient-centered medicine began as a
  as a whole. We then compare conceptual models for both                    descriptive account of how physicians should interact
  cultural competence and patient centeredness at both the                  and communicate with patients. In 1984, Lipkin and col-
  interpersonal and healthcare system levels to demonstrate                 leagues described the patient-centered interview as one
  similarities and differences. We conclude that, although                  which “approaches the patient as a unique human being
  the concepts have had different histories and foci, many of               with his own story to tell, promotes trust and confidence,
  the core features of cultural competence and patient cen-                 clarifies and characterizes the patient’s symptoms and
  teredness are the same. Each approach holds promise for                   concerns, generates and tests many hypotheses that may
  improving the quality of healthcare for individu
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