Person-centered care (PCC) is an approach to health care that puts personal values and preferences of the patient at the forefront of decision-making. Improving healthcare safety, quality, and coordination, as well as quality of life, are important aims of caring for older adults with multiple chronic conditions and/or functional limitations. Person‐centered care is an approach to meeting these aims in a way that assures the primacy of individuals’ health and life goals in their care planning and in their actual care.
Person‐centered care means that individuals' values and preferences are elicited and, once expressed, guide all aspects of their health care, supporting their realistic health and life goals. Person‐centered care is achieved through a dynamic relationship among individuals, in and out of the health care system, and others who are important to them, and all relevant providers. The required collaboration informs decision‐making to the extent that the individual desires. See, "Implementing “Patient‐Centered Care”: A Revolutionary Change in Health Care Delivery." Person-centered care is consistent with, and one could argue, the objective of "supported decision-making," upon which Aging in Place Planning is based.
According to an article published in the American Geriatrics Society Newsletter, two new research articles and a corresponding commentary from leaders in the the American Geriatrics Society (AGS) describe ways to make person-centered care more actionable for seniors. The study authors explain that the time is ripe for reform of senior care toward PCC:
"The U.S. healthcare system is finally at a much anticipated and long‐needed tipping point. For more than half a century, the predominant paradigm for organizing and financing health care in the United States has been based on [two] 2 major factors: care focused on organ systems and reimbursement based on volume rather than quality of service. This system has too rigidly driven what can be done and reimbursed and does not foster care that addresses disorders of multiple organ systems (multimorbidity) and the effect of multimorbidity on overall functional ability, considerations that are critically important in the care of older people. Given recent developments in our healthcare system, the time is ripe for geriatricians to leverage their unique expertise to advocate for a person‐centered approach to healthcare design and delivery that encourages healthcare professionals to organize care around patient priorities, rather than an outdated taxonomy and payment system."
"Making person-centered care a reality for older adults with complex care needs will take time and effort, including significant research to move promising approaches from the lab bench to the clinic,” wrote William B. Applegate, MD, MPH, AGSF, Editor-in-Chief of JAGS and lead author of the editorial addressing the two new studies (DOI: 10.1111/ jgs.15536). “This work is helping test innovative strategies, which will move us toward a broader and more balanced approach to care.”
Though critically important, eliciting and documenting personal values remains uncommon in routine older adult care, particularly for people with multiple health concerns that complicate pinpointing broader health priorities. In “Development of a Clinically Feasible Process for Identifying Patient Health Priorities” a research team describes Patient Priorities Care (PPC), a novel process to identify health goals and care preferences for older people with multiple health conditions. Expertly trained facilitators help older adults and caregivers work through health priorities sensitively, in a process that could be completed across just two sessions totaling 45 minutes or less. According to the research team:
“Results of this study demonstrate that healthcare professionals can be trained to perform the patient priorities identification process as part of their clinical encounters…[through a process that is] rewarding and enjoyable but requires training and formal feedback.”
A separate team put the PPC processes into practice, reporting their findings in “Feasibility of Implementing Patient Priorities Care for Patients with Multiple Chronic Conditions” Their study involved using Patient Priorities Care among more than 100 patients working with nine primary care providers and five cardiologists in Connecticut. While researchers still hope for improvements in the time needed to complete the process and in avenues for embedding it within practice workflows, they noted that the vast majority of patients returned to their physician with clear goals and care preferences. Follow-up discussions between patients and providers suggest that moving from disease-based to priorities-aligned decisions is “challenging but feasible.”
The foregoing work represents only the latest steps forward for high-quality, person-centered care for older people, and also builds on an even lengthier legacy at AGS. Implementation of these strategies for all seniors, even those receiving care outside of institutions, while aging in place, will be a welcome development.
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