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Patient Care Improves Quality

Health research demonstrates the benefits of reorganizing the provision of health services around what is most important for patients. As indicated in the section "Crossing the Qualitative Gap", patient-centered care is based on the principle that people should be the ultimate referees in choosing the type of treatment and care that they receive. Nevertheless, practice is still usually organized around what is most convenient for the provider, payer or health organization, and not for the patient. Patients were repeatedly asked, for example, to change their expectations and schedules so that they correspond to the needs of the system. They must provide the same information to several trustees or when they visit one and the same provider sequentially. Primary care appointments are usually not available outside of working hours. Consultations, education and coaching, necessary to help patients make informed decisions, have historically been neglected. In addition, patient insurance policies often limit the choice of provider, especially if the provider is not a doctor. Box 2-1 presents an example of how one health care system, the University of Pittsburgh Medical Center, has implemented a truly patient-centered program.

A number of studies are related to patient orientation and quality. For example, studies comparing operations with the vigilant expectation of patients with benign prostatic hyperplasia showed how strongly the preferences of patients played a role in determining the quality of life. It has also been found that the involvement of patients more directly in the management of their own condition leads to significant improvements in health for people with insulin-dependent diabetes mellitus. By 2001, so many different studies have found similar results that the "Crossing of the Qualitative Gap" has identified patient orientation as one of the six pillars on which the health system of the 21st century should be built (others - safety, effectiveness, timeliness, and justice).

One of the hallmarks of patient-centered care is improved access to care, the key component of which is access to information. For example, an increasing number of patients have greater access to their laboratory results and diagnostic reports of their procedures through electronic forums such as personal medical records and patient portals.

In 2001, an 18-month-old Josie King was hospitalized at the John Hopkins Children's Center with burns that she sustained as a result of a bathroom accident. First, Josie responded well to treatment, but her condition quickly deteriorated. When her mother, Sorrel King, expressed concern, state nurses and doctors repeatedly fired them, and two days before her scheduled release, Josie died. The cause was dehydration and mistakenly injected opioid - the result of a series of errors recognized by the hospital.

Ms. King has since dedicated herself to the elimination of medical errors, the creation of the Josie King Foundation and the appeal to clinicians, politicians and consumers about the importance of creating a "safety culture". And the need for this. According to the 2000 report of the Institute, up to 98,000 people die every year from medical errors (IOM, 2000); almost 10 years after the publication of this report, in spite of the improved patient safety systems, the C + + report was given in the 2009 report for efforts to expand patient capabilities to prevent errors (Wachter, 2009).

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