Patient-Centered Care Slide 1 Welcome. Good [morning/afternoon]. I’m Dr. [Name], an orthopaedic surgeon at [office]. Our focus today is on a concept in healthcare – Patient-Centered Care: what it is, how the American Academy of Orthopaedic Surgeons is supporting it, and what you can do to participate in, and benefit from Patient-Centered Care. Slide 2 The information in this presentation was provided to me by the AAOS and may be modified. Endorsement of this presentation by the AAOS is not implied or inferred. Slide 3 An orthopaedic surgeon is a medical doctor with extensive training in keeping your bones, joints, ligaments, muscles, tendons, cartilage and spine in good working order. Together, all of these parts of our bodies make up our musculoskeletal system Patient-Centered Care Slide 4 Orthopaedic surgeons are the physicians with the greatest knowledge of the musculoskeletal system and most experience treating musculoskeletal injuries, many of which do not involve surgery. However, if surgery is the best treatment often for the disease or illness, orthopaedic surgeons are the healthcare providers who are specifically trained for such treatment. Slide 5 As this chart shows, it typically takes 16 years or more of formal education and training to become a board certified orthopaedic surgeon. Beyond that, special certification is essential as orthopaedics is a field that is continually growing and evolving that requires life-long learning. Slide 6 Orthopaedic surgeons use the most effective and efficient diagnostic tools and our experience in musculoskeletal treatment to determine the best course of treatment for our patients. Patient-Centered Care Slide 7 Between orthopaedic surgeons, there may be some variation in how specific conditions are treated. This is based on individual training, experience, and community need. The concept of Patient-Centered Care (PCC) may also vary between doctors. The AAOS defines PCC as the provision of safe, effective, and timely medical care achieved through cooperation among the physician, an informed and respected patient (and family), and a coordinated healthcare team. Slide 8 The history of Patient-Centered Care initiatives in America can be traced to the human rights activism movement of the 1960s. A decade later, formal programs for a small number of healthcare facilities had been instituted by a commercial organization, Planetree, Inc., which continues currently. Over the past several years a wide spectrum of healthcare literature has reviewed the concepts of Patient-Centered Care. Slide 9 The Committee on Quality Health Care in America was formed under the auspices of the Institute of Medicine in 1998, with a challenge to develop strategies that would result in substantial improvement in the quality of healthcare over the next 10 years. Their early report “To Err is Human: Building a Safer Health System” was widely reviewed and received massive media coverage. This report found that medical errors were resulting in tens of thousands of unnecessary patient deaths each year, and therefore it effectively helped spawn a modern patient safety movement. Patient-Centered Care Slide 10 An example of one of the many initiatives tied to that publication was the federal government action to fund research and a demonstration project on patient safety. President Clinton asked for an action plan within 60 days, and Congress allocated 50 million dollars for the Agency for Healthcare Research and Quality to support research and demonstration on patient safety. Slide 11 Other organizations grew following the “To Err is Human” report, such as the Leapfrog Group. The Leapfrog Group is an association of powerful private and public sector healthcare purchasers that has created a market- based strategy to improve patient safety; in other words, they tell healthcare providers, “You do these things to ensure patient safety, and we’ll purchase healthcare from you.” Examples of these things include: utilizing computerized physician order entries in the hospital, and staffing ICUs with physicians who have special credentials in critical care. Slide 12 A more recent publication from the Institute of Medicine is entitled “Crossing the Quality Chasm.” It confirms that quality healthcare should meet patient’s needs and be based on the best scientific information. However, it provides good evidence that in America, this is often not the case. They reported a “chasm” between what we have in healthcare today and what we should have. Patient-Centered Care Slide 13 This report was also widely read and generated significant media coverage. An interesting table from the publication contrasted proposed new rules for 21st-Century Health Care with the typical current approaches. For example, the table notes that currently, professionals control care, but notes that under the new rules, the patient is the source of control. Slide 14 Six aims for improvement offered in this report included that healthcare should be: safe – ensuring the care you receive will not harm you; effective – the care is based on scientific knowledge of what works best; timely – waits for care or delays in delivery of care are kept to a minimum; efficient – the elimination of waste in equipment, supplies and energy; equitable – ensuring that all people receive quality care, regardless of gender, ethnicity, geographic location, or socioeconomic status; and be patient centered – providing care that is responsive to individual patient preferences, needs, values, and assuring that patient values guide all clinical decisions. Slide 15 A somewhat unexpected pair of co-authors, Senators Bill Frist and Hillary Clinton, wrote an article for the Washington Post in which they commented on healthcare problems in our country – and recognized an emerging bipartisan consensus that the challenges facing U.S. health care require major, transformative change. They acknowledged the importance of Patient-Centered Care, writing that: “The success of US health care depends on patients’ taking charge of their care and becoming active participants in it. Information and access to it will be paramount. Consumers and patients do not have enough information to make good choices.” Patient-Centered Care Slide 16 Although many physicians believe that they perform patient-centered medicine, that belief is often based on the original concept – to listen to the patient well. Thirty years ago, simply listening well to the patient’s complaints and symptoms before making a diagnosis was a paradigm shift in the practice of medicine. Others may argue that “doing the best thing for the patient” is delivering patient-centered care. However, today’s concept turns that upside down. Slide 17 More and more patients are demanding a change in the way health care is delivered. Public interest has been mirrored in many publications, such as this example from U.S. News and World Report in November 2004. Slide 18 These reports from the Institute of Medicine as well as those from other groups and the media have all contributed to the growing concept of Patient-Centered Care, which is now filtering through all levels of the healthcare complex. Some of the examples shown confirm the interest in PCC by hospitals, healthcare providers, corporate purchasers of healthcare, and the healthcare insurance industry as well as federal, state, and local governments. Patient-Centered Care Slide 19 In a recent interview, Harvard medicine professor Dr. Tom Delbanco confirmed that a report he co-authored in the 1980s may have been one of the first to use the actual term, “Patient-Centered Care.” He remains unsettled that those specific words are the best, but they have become the most widely accepted. Regardless of the terminology, he supports the concept that “seeing things through the eyes of the patient” is best for healthcare. Slide 20 The motivation for healthcare facilities and providers to support patient- centered care has come from many sources. Specific healthcare advocacy organizations, often originally founded by patients or their families, have long recognized the value of the patient’s individuality and wishes. Examples include organizations of cancer survivors. Other motivation has come from patient satisfaction surveys. Hospitals recognize that to increase market share, patient centered care programs can be very helpful. More recently, the desire to improve patient safety and outcomes of their care has driven facilities to include patient-centered care in their design and function. Slide 21 National organizations, government agencies, and even corporate America are encouraging Patient-Centered Care. An example from the National Health Council is their program entitled “Putting Patients First” which has created public service advertisements, publications, and web site information to emphasize the importance of patient participation in their healthcare. Patient-Centered Care Slide 22 So far, the patient-centered care initiative has been somewhat voluntary, although steps are being initiated by regulatory agencies and certifying organizations to further motivate healthcare facilities, or even require them to include concepts of patient-centered care. Slide 23 “Speak Up,” the Joint Commission's award-winning patient safety program, encourages patients to learn about their diagnosis, tests, treatment and medications. Encouragement is given to ask questions and to involve family members or friends. The Joint Commission offers brochures such as the one shown here, for hospitals to distribute to patients. Slide 24 Hospitals and their associations are investing in more training for their personnel in the areas of patient- and family-centered care. An example is this training video for hospital leadership developed by the American Hospital Association. Patient-Centered Care Slide 25 Hospital-based components of Patient-Centered Care have included such issues as more flexible visiting hours, architectural design elements to increase comfort for the patient and family, health information libraries on site, greater respect and acceptance of the patient’s family or care partner, supervised access to medical records, and less strict patient dress codes. Slide 26 At the institutional level, the easiest steps toward patient-centered care have been changes made to the physical plant, creation of patient information libraries, and adding community members to advisory boards. Slide 27 The greatest successes of patient-centered care have come in pediatric hospitals and cancer centers. Patients with chronic or longer term conditions such as diabetes or heart disease have proven more adaptable to many patient-centered care concepts. Successful implementation is more likely if there is a small core of dedicated physicians, but success has been less common for general medical-surgical patient wards. Patient-Centered Care Slide 28 When patient-centered care has been implemented in physicians offices, several benefits have been documented, including: decreased litigation, less defensive medicine, better patient adherence to treatment plans, and improved outcomes of care. In contrast, the greatest documented improvement in acute care facilities that have instituted patient-centered care has been in improved patient satisfaction. Slide 29 The patient-centered care concept has been pushed by concerns about patient safety issues, discrepancies in care and demand for better accountability in healthcare. Each of these provides stimulus, but don’t necessarily result in mandates. In the future, however, there may be requirements for patient-centered care implementation with some of the most powerful leverage coming from licensure requirements or ties to reimbursement. Slide 30 A third report from the Institute of Medicine which studied the education of health professionals has called for the inclusion of patient-centered care training as a component of formal medical training, and this concept has been integrated in medical training programs throughout the country. Patient-Centered Care Slide 31 An example of implementation of such a PCC education program is this three-year, required course at Loyola University Chicago’s medical school. Slide 32 Why is AAOS involved? With 35,000 members worldwide, it is the largest association of musculoskeletal specialists. Now over 75 years old, it is a not-for-profit organization that provides education services to orthopaedic surgeons and allied healthcare givers as well as advocates for improved patient care. Slide 33 The primary mission of AAOS is to improve the quality of healthcare provided to patients with musculoskeletal conditions treated by its members. Patient-Centered Care Slide 34 After considering many reported aspects of patient-centered care, the AAOS board has approved this definition, which will guide the AAOS PCC initiative: “Patient-Centered Care is the provision of safe, effective and timely medical care achieved through cooperation among the physician, an informed and respected patient (and family) and a coordinated healthcare team.” Slide 35 Seventy-five years ago, as well as today, “doing the best thing for the patient” has utmost importance when rendering orthopaedic care. However, in those days, patients and their families had different communication options and expectations for care than they do now. Slide 36 Today’s healthcare expectations are different. Access to care can be timlier and options are more sophisticated. Patient-Centered Care Slide 37 AAOS recognizes that aspects of Patient-Centered Care can lead to improvements in the quality of healthcare provided to patients with musculoskeletal conditions. AAOS has developed initiatives to support PCC. AAOS has long provided print materials for patient education, and the Web site, Your Orthopaedic Connection, continues to improve as a great source of current musculoskeletal information. Through AAOS seminars and education programs, orthopaedists are learning new skills in communicating effectively with their patients and improving cultural competency. Patient safety concerns are a high priority for AAOS. An example is the leadership role taken to establish the “Sign your Site” program to help avoid wrong-site surgery. Slide 38 AAOS has a wealth of print materials available for patient information, including this recent book. The Your Orthopaedic Connection Web site increases in depth on a monthly basis. Slide 39 The AAOS patient education Web site is a great source for information on a variety of musculoskeletal topics. These topics related to PCC can be found using the web site search engine. Each provides tips for better patient/physician interaction. Patient-Centered Care Slide 40 AAOS recognizes the importance of quality communication with patients. Members are encouraged to show patients empathy and respect, to listen attentively, to elicit concerns and calm fears, to answer questions honestly, to inform and educate patients about treatment options and the course of care, to involve patients in medical care decisions, and to demonstrate sensitivity to patients’ cultural and ethnic diversity. Slide 41 An example of AAOS’s evidence-based practice guidelines is this extensive compendium. This publication includes practices and information based on clinical evidence that demonstrates what works best for patients. Slide 42 Patient advocacy efforts to increase access to musculoskeletal care as well as encourage funding of musculoskeletal research is important at AAOS. Patient-Centered Care Slide 43 Future plans call for AAOS to enlist more support for PCC through patient satisfaction surveys, medical personnel education, a pledge for orthopaedic surgeons, and an expanded patient education web site. Slide 44 Workshops and symposia for physicians will be given at meetings with summaries printed in AAOS periodicals. Slide 45 An affirmation statement has been prepared for orthopaedists to endorse as confirmation of their support for the principles of PCC Patient-Centered Care Slide 46 PCC should have value for all patients. Ideally, PCC will result in improvements in healthcare in all of these areas. Slide 47 Reliable studies have confirmed that PCC initiatives can result in better outcomes and lower costs for patients who are involved in their care. And, for physicians, there is greater satisfaction for themselves, a decreased liability risk, and increased satisfaction of their patients. Slide 48 PCC does require a partnership. To be effective, patients must be an active part of the team. Patient-Centered Care Slide 49 A passive attitude will not result in the best outcomes. Slide 50 It can be difficult to communicate, to understand, or even to think clearly when health problems present. Therefore, it often helps to have a family member or friend available to help listen with a patient. Slide 51 One way many patients try to stay informed is by seeking health information online. Although the Internet can be a great source of information, there are precautions to take when using it for healthcare information. The following tips from the National Institute of Arthritis and Musculoskeletal and Skin Diseases can also help you find quality health information online: Compare information you find on the Internet with other resources. These can include medical textbooks, medical journals, or information from organizations such as the National Osteoporosis Foundation or the Arthritis Foundation. Check credentials of the author or organization. These should be clearly displayed on the Web site. Be wary of personal testimonies. experience rather than objective facts or proven medical research. Also be cautious about using information from online bulletin boards or chat sessions. Be cautious of Web sites that advertise and sell products. Patient-Centered Care Some reliable Web sites provide health information. These include Web sites of government agencies, health foundations or associations and medical colleges. Check the posting date. Information changes rapidly in health care. Old information may no longer be current. Talk with your doctor about the information you find on the Internet. This is especially important if you find information or advice that seems to contradict what your doctor told you. Slide 52 Tips on partnering with your doctor effectively are available on the AAOS patient education Web site, orthoinfo.org. Slide 53 As a team member, the patient should be expected to not only speak up and question, but take an active part in adhering to treatment plans and communicating with physicians, as well as finding out about and understanding test results. Patient-Centered Care Slide 54 You can also remind your physician to provide you with specifics about your diagnosis, treatment options, the course of care, expectations for surgical outcomes, and the risks and complications of surgery or other treatments. Slide 55 As a patient, communication with healthcare providers is important, and should be encouraged. Don’t hesitate to ask question and voice concerns, speak up if you don’t understand something, and always be honest and complete with the information you provide your physician. Never forget that you and your physician are partners in maintaining your health. Slide 56 For more information about musculoskeletal conditions and patient- centered care, visit the Web site of the AAOS at aaos.org/pcc. Patient-Centered Care Slide 57 What questions or concerns do you have that we have not addressed yet? Slide 58 Thank you for participating today. I hope that you have each learned something helpful about the concept of Patient-Centered Care – particularly your opportunities to partner with your orthopaedic surgeon in mutually deciding on and working together for the best care of musculoskeletal conditions.