The Year of Health System Transformation to High Quality Patient-Centered Care
Robin Newhouse, PhD, RN, is a grantee of the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative. She is professor and chair, Organizations Systems and Adult Health at the University of Maryland School of Nursing. She is also vice-chair of the Methodology Committee for the Patient-Centered Outcomes Research Institute. This post is part of the "Health Care in 2013" series.
My resolution for the U.S. is to begin the transformation of health care systems to enhance high quality patient-centered care. Despite some improvements, the National Healthcare Quality Report 2011 reveals that health care quality in the U.S. often falls short of expectations—demonstrating geographic and population (minority and low-income) variations. In 2011, the U.S. Department of Health and Human Services (HHS) released the National Quality Strategy (NQS), designed to improve the quality of health care in the U.S. My highest priority for action is the first aim: “Better Care: Improve the overall quality of care, by making health care more patient-centered, reliable, accessible, and safe.” Better care is achievable—with two specific strategies in mind: implementation of evidence-based practices and a focused goal to measure and improve patient-centered outcomes.
Implementation of Evidence-Based Practices. We have not gone far enough, fast enough. It is time to focus on implementation of evidence-based practices in health care systems. Research studies have continued to exponentially produce results intended to inform health care practices. Identifying and implementing evidence-based practices known to work—but that are underutilized—can go a long way to improve health care processes and quality. Performance measures are an example of one approach to drive system changes. The 2012 NQS Annual Progress Report describes the achievements of the first year’s work, including a focus on clinical and patient-reported outcomes (as close as possible to patient-centered) and development of new patient-centered outcomes.
Measuring and improving patient-centered outcomes. The health care transformation will also come through new partnerships with patients and our community, and the measurement of outcomes that are important to them. The Patient-Centered Outcomes Research Institute (PCORI) began its work in 2010, to support research that informs decisions by patients and their health care providers. The definition of patient-centered outcomes was developed through a rigorous transparent process with extensive community and stakeholder engagement, and is written in the voice of the patient. Research results generated through PCORI grants will have high utility to both patients/caregivers and their health care teams because of the expected patient/caregiver engagement.
Both strategies to foster health system improvements will entail innovation. Implementation of evidence-based practices will result in changes in structures and processes of care. Measuring and improving patient-centered outcomes will necessitate building relationships with patients and infrastructure needed to collect outcome data.
Health system transformation is a bold resolution, but to provide better care is a common vision of interdisciplinary health care teams, patients and caregivers.