TEDMED #GreatChallenges: Connecting the Dots in Patient-Centered Care

Kavita Patel M.D. – the moderator of this TEDMED event, managing director for clinical transformation and delivery at the Engelberg Center for Health Care Reform and an economic studies fellow at the Brookings Institution – was recently named a Young Global Leader by the World Economic Forum. The Forum of Young Global Leaders is a multistakeholder community of exceptional young leaders who share a commitment to shaping the global future. Each year, the World Economic Forum identifies 200-300 extraordinary individuals worldwide. Together, they form a powerful international community that can dramatically impact the global future.

Even the most well thought-out care plan has the potential to fail if the patient’s individual life circumstances are not taken into account. Consider these examples:

  • A man who insists on antibiotics for a tooth abscess because he is afraid of the dentist
  • A woman who won’t go to the hospital for testing because she has no one to care for her cat
  • A child who goes without a prescription because her parents cannot afford the copay

To help address these kinds of issues, proponents of patient-centered health care work to increase patient involvement and consider the patient’s personal context when designing care plans. A recent TEDMED Great Challenges Program (TEDMED Great Challenges: Connecting the Dots in Patient-centered Care) explored this topic in a Google Hangout that brought together a community of stakeholders, thought leaders and interested parties in a synergistic online forum with the goal of influencing a better future in health and medicine.

Moderator Kavita Patel, M.D., is the managing director for clinical transformation and delivery at the Engelberg Center for Health Care Reform and an economic studies fellow at the Brookings Institution. In addition, she is a practicing primary care internist at Johns Hopkins Medicine and the former director of policy for the Office of Intergovernmental Affairs and Public Engagement for the Obama administration.

The Experts

The panel of experts assembled for this TEDMED Great Challenges Program hangout each had a story about how they have been touched by the problems created when contextual issues are not considered, either as health care workers, patients or both.

Saul Weiner, M.D., an internist and pediatrics researcher at the University of Illinois at Chicago, was inspired by his experience supervising medical residents and helping them explore and identify pathways to improve individualized treatment decisions. His research led to the term “contextual errors” to describe “medical errors that result from failures to identify or take into account factors in patients’ lives and circumstances that are relevant to their care.”

Alan Spiro, M.D., used the experience gained from 25 years in health care delivery and management leadership to become a founding member of Accolade — an innovative approach to improving the consumer health care experience. Accolade’s mission is “to help individuals get the right care the first time.”

Susan Sheridan, M.B.A., M.I.M., is the director of patient engagement at the Patient-Centered Outcomes Research Institute (PCORI). Sheridan became involved in patient safety and patient advocacy after experiencing the heartbreak of two separate medical system failures that resulted in the death of her husband and brain damage in her infant son.

Key Insights

The topics covered in the hour-long discussion ranged from implications for research to practical, everyday advice for stakeholders. The panelists shared the following insights:

  • Contextual errors can result from any factors that are somehow relevant to the patient and affect treatment.
  • The best time to involve patients in care is before care is rendered.
  • Evidence from both the marketplace and research show that contextual errors lead to unnecessary spending and waste.
  • People need guidance through the complex and fragmented health care system.

Along with patient-centered care, the panelists also emphasized the need for more patient-centered research. They advocated the use of community-based participatory research (CBPR) methods to infuse the patient wisdom into research design to create meaningful outcomes. A shift to CBPR methods would also benefit from a change in evaluation measures to help physicians improve their patient-centered skills. The panelists recommended sharing this new patient-informed research directly with patients in an easily accessible way.

Strategies and Takeaways

Because every patient’s needs are different, there is no one strategy that will work in every instance. However, the panelists discussed several strategies for improving individual care:

  • Get the right care at the right place at the right time. Utilize e-medicine and telemedicine care teams to help patients become involved and provide patients with the attention they need.
  • Give care teams continuing education regarding behavior-change strategies to supplement medical education.
  • Encourage and empower patients to be “at the table” not only for their own care but for research, policy and overall patient engagement.
  • Invite patients onto their own care team. Or, as a patient, advocate for that invitation.
  • Provide and use information as a source of power.
  • Develop metrics to see if interactions are truly patient centered.

This Great Challenges discussion concluded that there is no “one size fits all” option when it comes to patient-centered care, but simple changes can work toward a paradigm shift, which can empower patients, providers and systems to work together toward positive individual outcomes.

MHA@GW is proud to support the Great Challenges Program at TEDMED, funded by the Robert Wood Johnson Foundation. Through weekly dialogues with TEDMED’s intellectually diverse community, we move toward a more meaningful understanding of the great challenges of health and medicine. Click here to learn more about the Great Challenges Program. To share your ideas, join in the discussion at #GreatChallenges.