Are We Delivering on the Promise of Patient-Centered Care?

The imperative of the Institute for Healthcare Improvement’s Triple Aim is to improve the patient care experience, improve population health, and reduce per capita health care costs. Health care organizations are reexamining their care delivery models in response to market changes brought about by the Affordable Care Act. Organizations are responding by experimenting with patient-centered delivery models, such as the Patient-Centered Medical Home (PCMH). The PCMH is based on more than three decades of research on the Patient-Centered Clinical Method (PCCM), which is organized around the theoretical framework of the Patient-Centered Model. In spite of health care providers’ best efforts to deliver patient-centered care, and perceptions that they are patient-centered in their care approach, patients do not always share these perceptions. Unless health care delivery is viewed as patient-centered from the patient’s perspective, health care organizations will not achieve their goal of patient-centeredness. The purpose of this case study was to explore whether we are delivering on the promise of patient-centered care by examining stories of patient visits within Federally Qualified Health Center (FQHC) PCMH practices. Two themes emerged: Negotiating Patients’ Experiences of Health Disparities and Difficulty Communicating Effectively. Examination of these themes provided insights into how they are operationalized in practice in FQHCs who serve underserved patients with health disparities. The FQHCs have varied models of how many supportive services are provided, and how they are provided. These variances impacted clinic operations. There were also differences in providers’ perceptions of patient engagement and outcomes, although these perceptions cannot be directly linked to the model in place at each clinic. FQHCs should examine and experiment with different care models that are best for their patient populations, to help providers improve communication and navigate health experiences with their patients to achieve the best outcomes. FQHCs should also collect and examine stories of provider and patient experiences in order to promote deliberate listening and actionable dialogue to enhance the patient-centeredness of the visit. Clinic operations should be organized around supporting strong provider/patient relationships. It is within the fabric of these relationships that social determinants and disparities may be addressed, and mutual understanding may be achieved