By Wayne Shields
President and CEO
Association of Reproductive Health Professionals
Patient-centered care, an effective healthcare model that has been moving in jumps and starts for more than three decades, received a significant boost several years ago with the implementation of the Patient Protection and Affordable Care Act of 2010 (ACA). Why did this model that emphasizes patient involvement, prevention, and quality improvement become such a fundamental part of healthcare services? And how can we translate this model into effective, high-quality sexual and reproductive healthcare?
Patient-centered care’s spectacular rise in the United States during the past three years is rooted in its potential effectiveness at improving healthcare quality and patient satisfaction while reducing costs.1 But mostly, its recent prominence can be tied to another key motivator for systems change. Patient-centered care is a significant feature of the ACA, which is now the law of the land.2
Even before it had a name, “patient centeredness” was being explored by academicians, health professionals, and socio-behavioral scientists. It was addressed almost 50 years ago, as poor health outcomes associated with disease-oriented, physician-centered models began to come into question. In his 1969 published lecture, Michael Balint proposed the radical notion that each patient “... has to be understood as a complete human being.”3,4 In 1984, Mack Lipkin presented patient-centered interviews as the cornerstone for effective care by internists.5
In 1987, the phrase “patient-centered care” was coined by the Picker Institute and the Commonwealth Fund to describe an emerging healthcare model focused on active patient involvement. The concept was further advanced in a 1993 book titled Through the Patient’s Eyes, which outlined seven key elements of the concept.6,7 Eight years later, the concept was introduced in the landmark Institute of Medicine (IOM) report, Crossing the Quality Chasm, describing patient-centered care as “. . . care that is respectful of and responsive to individual patient preferences, needs, and values” and that ensures “that patient values guide all clinical decisions.”8 The federal government’s Agency for Health Research and Quality took the next step, with its early focus on patient-centered care and emphasis on the medical home and accountable care organizations as potentially successful environments for effective patient-centered care.9 Finally, with ACA passage in 2010, policymakers classified patient-centered care as an essential element of the law, and established the Patient-Centered Outcomes Research Institute to “improve the quality and relevance of available evidence to help patients, caregivers, clinicians, employers, insurers, and policymakers make informed health decisions.”10
We can’t yet claim success integrating patient-centeredness into health practice nationwide, especially sexual and reproductive health care. Community health centers, which make up many of the thousands of safety net clinics across the country, have been the central focus for ACA implementation. But they are struggling to meet the needs of their millions of new patients and are doing their best to incorporate ACA-directed patient-centered services in general. Sexual and reproductive health has yet to become a priority.
Fortunately, our field has expertise to share. For example, Title X family planning clinics have set the standard for incorporating high-quality patient-centered care into their clinics, and some key healthcare systems, such as Unity Health Care in Washington, DC, have integrated patient-centered care into their family planning programs. We have tools for change, including the Centers for Disease Control and Prevention’s (CDC’s) and the Office of Population Affairs’ (OPA’s) recent guidelines for providing quality family planning services and coalition work on quality metrics, health professional competencies, and workforce development and training.11,12
Here is what we can do to advance patient-centered care in sexual and reproductive health:
- In the area of workforce development and training, increase the numbers of primary care providers who are trained in sexual and reproductive health.
- Incorporate the CDC/OPA family planning guidelines and well-tested reproductive health metrics into all levels of care, especially in primary care safety net systems.
- Adopt contraceptive and family planning competencies into post-graduate clinical education and certification standards for all appropriate disciplines and specialties.
- Integrate patient-centered guidelines and metrics into electronic health records.
- Advocate for replicating public health-oriented patient-centered care models in private practice.
We have come a long way from a physician-only medical model toward team-based patient-centered care. For our nation’s primary care systems to be truly patient-oriented, we need to recognize sexual and reproductive health as essential elements of care.
- Bechel DL, Myers WA, Smith DG. Does patient-centered care pay off? Jt Comm J Qual Improv 2000; 26(7):400-409.
- Department of Health & Human Services. Read the Affordable Care Act. Accessed at http://1.usa.gov/1LdDD0h.
- Balint E. The possibilities of patient-centered medicine. J R Coll Gen Pract 1969; 17:269-276.
- Barry MJ, Edgman-Levitan S. Shared decision making — The pinnacle of patient-centered care. N Engl J Med 2012; 366(9):780-781.
- Lipkin M Jr, Quill TE, Napodano RJ. The medical interview: A core curriculum for residencies in internal medicine. Ann Intern Med 1984; 100(2):277-284.
- Picker Institute. Picker principles of patient centered care. Accessed at http://bit.ly/1ILYCI5.
- Gerteis M, Edgeman-Levitan S, Daley J, et al. Through The Patient’s Eyes. San Francisco: Jossey-Bass; 1993.
- National Research Council. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001.
- Stanton M. Agency for Healthcare Research and Quality. Expanding patient-centered care to empower patients and assist providers. AHRQ Research in Action 2002; 5. Accessed at http://1.usa.gov/1ESP5t5.
- Patient-Centered Outcomes Research Institute. Why PCORI was created. Accessed at http://bit.ly/1ILZiNy.
- Gavin L, Moskosky S, Carter M, et al; Centers for Disease Control and Prevention (CDC). Providing quality family planning services: Recommendations of CDC and the U.S. Office of Population Affairs. MMWR Recomm Rep 2014; 63(RR-04):1-54.
- Sexual and Reproductive Health Workforce Project, Metrics and Performance Working Group. Proposal for new contraception metrics. Accessed at http://bit.ly/1L1xYd7.