Healthcare is ever evolving; since the US Affordable Care Act (ACA) of 2010 emphasis has been placed on providing affordable, accessible, safe, quality, patient-centered care (PCC). The US healthcare has been transitioning from a fee-for-service model to a value-based model which focuses on patient preferences and satisfaction of care received, with reimbursements reliant on patient satisfaction surveys. Barriers to access to healthcare persist, however, a study by Hong et al. (2019) found that these barriers can be mediated by PCC. In addition, two of the Quality and Safety Education for Nurses (QSEN) graduate competencies are PCC and evidenced-based practice (EBP), and EBP includes patient preferences in clinical interventions. Also, the World Health Organization acknowledges the role PCC has in improving quality and efficiency of healthcare. Patients perceive PCC favorably and feel that patient preferences, adequate information and teaching, transition of care, emotional support, family and friend participation, management of care, physical comfort, and access to care improve the quality of care they receive. PCC is associated with better health outcomes, decreased costs, improved quality of care, and can potentiate access to care.
Patient-centered care (PCC) is a healthcare model that differs from previously used patriarchal healthcare models. The concept of PCC is to incorporate patient values and patient preferences into healthcare by a collaboration between healthcare providers and patients, with the common shared goal of patient-centered, quality healthcare. PCC provides that the patient is in command of their care, and quality and value of care is determined by the values and needs of each particular patient. PCC is considered holistic care because it involves treating the whole patient, body, mind, and spirit, while considering patients’ values, culture, beliefs, and preferences. The PCC model involves healthcare providers and the patient, including the patient’s family, working as a team to create and deliver individualized, personal healthcare treatments, putting the patient as the main focus of healthcare. In summary, PCC involves collaboration between healthcare professionals and their patients to develop and implement individualized, personal care which increases the quality care while decreasing the costs of healthcare, with the potential to improve access to healthcare.
PCC can improve quality of care. PCC is related to better health outcomes, increased patient satisfaction, increase safety, and increased quality of life. PCC includes patients and families in care, which can prevent safety events. The Joint Commission’s ‘Speak Up’ campaign encourages patients and family members to ‘speak up’ or talk with their healthcare team, to voice their safety concerns; this is a PCC approach to maintaining safe quality care. PCC contributes to increased quality of care with the use of evidence-based practice (EBP), the gold standard for healthcare delivery of care. EBP utilizes evidence from high quality research, clinical expertise, and patient values, beliefs, and preferences to develop best healthcare practices. Patients value personal relationships with their healthcare team, quality communication, shared decision making about medications and diagnostic testing, and nurtures patient-provider relationships which promotes healing. In addition, PCC can help healthcare providers identify barriers to access of care, such as geographic or financial barriers. Healthcare providers can link patients with appropriate resources to assist patients with the barriers that they face. PCC improves the patient experience, improves patient satisfaction with care, improves outcomes, improves patient participation in care, improves safety, and reduces costs of care.
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Access to care is a healthcare system’s capacity to deliver efficient, cost-effective healthcare. In the United States, the Affordable Care Act decreased the number of uninsured Americans and improved access to healthcare for many Americans. However, even with insured Americans, barriers to access to healthcare still exist: health literacy, financial barriers and geographic barriers. PCC improves patient perception of quality of care and, in turn, leads to higher perceived access to care. The PCC model recognizes and addresses financial, geographic, and health literacy barriers and refers patient to necessary resources to overcome barriers. Also, the PCC model addresses timely access to care, including available healthcare after working hours, long wait times for appointments, operations, procedures, referrals, and consultations. PCC addresses time access, which decreases hospitalizations, decreases the use of emergency room visits, and improves outcomes for patients with chronic illness. PCC addresses financial barriers to access, including the cost of prescription medications, costly procedures, and high fee ambulance services. Long distance commutes to healthcare providers and financial issues remain barriers to care; however, PCC is able to reduce perception of these barriers by improved perceived access to care, improved patient satisfaction, and improved patient outcomes. PCC can improve access to healthcare services by addressing barriers to healthcare and by improving patient satisfaction and perception of care.
The rise in healthcare costs has led to hospital systems utilizing a PCC model because it improves patient care, decreases redundant use of healthcare services, which leads to efficient healthcare and decreased costs. In fact, a randomized control trial by Pirhonen et al. (2020) concluded that PCC, compared to a control treatment as usual group, decreased costs of healthcare and improved overall quality of life for patients with COPD and CHF, two costly chronic medical illnesses. Patient perceived quality of care is directly correlated to hospital reimbursements. Hospital systems participating in Medicare and Medicaid Services are reimbursed using a value-based system and results of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction survey. Consumers may view hospital HCAHPS scores online and make decisions about where they choose to obtain healthcare. Furthermore, hospital reimbursements and penalties are based off of HCAHPS scores, or patient satisfaction with their care. High HCAHPS scores are related to strong healthcare provider communication skills and with patient needs being met. Patients are equal members of the healthcare team that make choices based on their values, beliefs and preferences. The consumer driven model of care requires healthcare providers to understand patient preferences to care and to educate their patients to improve efficiency of care and decrease costs. PCC improves patient satisfaction; healthcare professionals have a big impact on patient satisfaction and are vital in decreasing costs of healthcare.
Summing up, PCC is a patient preferred model of healthcare. Understanding and valuing patient preferences and perspectives is an important concern for healthcare providers. PCC allows the patient a seat in the treatment team, where the patient becomes an active member and decision-maker in their own healthcare. Healthcare providers are needed to improve health literacy, to educate and teach our patients, while respecting the patient’s values and beliefs. Today, patients are interested in having control in their healthcare decisions and treatments, and benefit from available options for treatment and care, rather than being told what to do. Healthcare leaders should always be considering the patient’s values and beliefs, the best quality of care, and effective cost-effective care decisions. A PCC approach to healthcare allows for personalized, individual treatment plans that considers the patient holistically and a treatment plan that considers the unique needs of the patient and the family. EBP use patient preferences to determine the effectiveness of the practice, realizing patient participation and satisfaction with healthcare practices are equally important in developing and maintaining EBP. PCC improves the quality and safety of healthcare, and improves patient participation in healthcare. In addition, PCC improves access to care, addressing barriers to healthcare that are not addressed by the increase in insured Americans after the ACA, such as long commutes to health care and financial barriers. Lastly, PCC can reduce the cost of healthcare. Improved patient satisfaction and HCAHPS scores increase hospital reimbursement rates and improve efficiency of healthcare delivery results in decreased costs. PCC is an effective model of care to improve access to care, improve quality of care, and to reduce costs of healthcare.
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