Patient-Centered, Clinically Integrated Care Delivery
DEFINITIONS
Each of the words within the patient-centered, clinically integrated (PCCI) model has been carefully chosen to describe a revolutionary change in how the US healthcare system should deliver care. Let’s examine each in more depth.
- Patient-Centered — The IOM (Institute of Medicine) defines patient-centered care as: “Providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions.” (1) The Institute of Medicine (now the National Academies of Sciences, Engineering, and Medicine) has listed patient-centered care as one of its six aims of quality in healthcare. They further define six key components of patient-centered care to include being respectful of patients’ values, preferences, and expressed needs; providing coordinated and integrated care; providing information, communication, and education to patients; ensuring physical comfort of the patient; providing emotional support to the patient; and involving family and friends. (2)
- Clinical Integration (CI) — This phrase has several definitions and can be viewed within both a clinical and a legal context. (3) The very essence of CI, to me, involves healthcare providers choosing to focus on providing value (quality/cost) to benefit their patients as opposed to providing high volumes of profitable services to benefit themselves or their employers.
While the above definitions may seem rather straightforward, each will be very difficult to make a reality. They involve changing an entrenched culture, and changing a culture is tough.
For that reason, the remainder of this article will outline a very proscriptive, step-wise approach that I believe will help facilitate this difficult transition. While I don’t pretend to have all the answers, I have been down this road a few times. As a result, I have tried to identify the major obstacles that must be overcome and have thought a lot about the best way to build a successful PCCI delivery system. That being said, I welcome input and advice from others who feel my recommendations are off-base or incomplete.
(1) Barry, Michael J., and Susan Edgman-Levitan. “Shared Decision Making — the Pinnacle of Patient-Centered Care.” New England Journal of Medicine 366, no. 9 (2012): 780–81. https://doi.org/10.1056/NEJMp1109283. https://www.nejm.org/doi/full/10.1056/NEJMp1109283.
(2) Baker, Alastair. “Crossing the Quality Chasm: A New Health System for the 21st Century.” BMJ 323, no. 7322 (2001): 1192. https://doi.org/10.1136/bmj.323.7322.1192. http://www.bmj.com/content/323/7322/1192.1.abstract.
(3) American Hospital Association. Clinical Integration — the Real Key to Reform. (2021). https://www.aha.org/system/files/research/reports/tw/10feb-clinicinteg.pdf.
