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The current enthusiasm for "patient-centered care" (a recent
Google search returns 6 million entries) can be confusing and
off-putting to many clinicians. Confusing because it has been
applied to a disparate set of care innovations, off-putting because
it seems to imply that clinicians need to be reminded to care
about their individual patients. VHA's new operational guide
for moving towards focused Veteran-centric care, the "Blueprint
for Excellence," describes "healthcare that is personalized, proactive, and patientdriven."
I find this definition helpful because it identifies distinct actions that together
put patients closer to the center of their care. First, patients need to determine what
they want from their care and, then, work with their care team to devise a treatment
plan matched to their specific desires, conditions, and abilities. As patients live longer
and accumulate more chronic conditions (and often more providers), what is most
important to them—which is often remaining independent and comfortable—may
get lost or be in conflict with the disease-specific clinical goals of their clinicians.
One of the transformational actions envisioned by the Blueprint is for the Office
of Patient Centered Care and Cultural Transformation to implement personalized
health plans that clarify each Veteran's personal life priorities and goals for their
health. These plans can then be used to coordinate care across different providers.
The second element is to make our care more proactive, focusing upstream on
how we can keep patients healthier rather than focusing all our attention after they
become sick. This shift in focus will require engaging resources in the community,
such as Veterans' service organizations as described in Jeff Whittle's article in
this issue. The final element is transforming into a "patient-driven" model of care
rather than one that revolves around the workflow of clinicians. This shift can entail
everything from making the hospital environment more welcoming for patients and
families; using mobile health to facilitate communication and scheduling; and most
important, engaging patients in their own care, as described in several of the articles
in this issue.
Engagement is not just about making patients feel better about their care—decades
of research have shown that levels of patient activation or engagement are strong
predictors of better health outcomes as well. The need for more engagement extends
to research. In HSR&D, we have recently formed a patient-engagement workgroup
which is charged with making recommendations to HSR&D leadership about how
to increase the engagement of our Veterans in the research priorities we pursue.
By increasing the "voice of the Veteran" in our research, we hope to increase the
chances that providers will adopt the findings of that research more quickly, resulting
in improvements that Veterans care about.
David Atkins, M.D., M.P.H., Director, HSR&D