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					                              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.