ADVERTISEMENT
Continence Coach: Today’s Landscape for Patient-centered Healthcare
Healthcare initiatives are becoming increasingly patient-centered in focus. One such effort in the past year specifically applies the concept to research. Nurse specialists should be aware of this initiative, because it represents potential opportunities for research funding. The initiative, the newly launched Patient-Centered Outcomes Research Institute (PCORI), seeks to help people make informed healthcare decisions (and improve healthcare delivery and outcomes) by producing and promoting high-integrity, evidence-based information that comes from research guided by patients, caregivers, and the broader healthcare community. The new institute is governed by a 21-member Board of Governors —19 are appointed by the US Government Accountability Office (GAO), and two are the Directors of the Agency for Healthcare Research and Quality (AHRQ) and the National Institutes of Health (NIH) or their designees. By early December 2011, the Board of Governors had received 856 applications for its Pilot Projects Grants Program.1 The call for patient-centeredness goes beyond the nobility of research imperatives. Another initiative involves evidence-based healthcare, embraced by public and private healthcare stakeholders as a solution to rising healthcare costs, poor quality, and safety concerns, but it has taken nearly 5 years for the legitimacy and importance of patient-centeredness to be acknowledged. Since 2006, the National Association For Continence (NAFC), along with nearly 50 other patient advocacy organizations across a wide variety of diseases and conditions, has promoted the following principles as core values2:
• Evidence-based healthcare should support individualized care and not dictate “one-size-fits-all” treatment;
• Each consumer should be treated individually based on needs, health status, history, and other individual factors;
• Any process developed for reviewing scientific evidence and translating those findings for decision makers should be clearly stated, flexible in nature, and include consumer representation;
• Acceptable research evidence should not be limited to randomized clinical studies. All types of research should be incorporated to ensure all racial/ethnic groups are included;
• Safety and finding the right treatment for the individual should be top goals of evidence-based healthcare;
• Evidence should support physician and consumer decision-making rather than dictate treatment.
As healthcare costs continue to spiral upward, its drivers become more concrete. Primary care providers are beginning to witness their compensation structure tied, at least in part, to patient satisfaction scores.3 Moreover, a growing momentum is attempting to shift a greater share of healthcare costs and responsibility for self-care onto the patient, as the escalating burden on public and private payors becomes unsustainable. Consequently, we are hearing more about shared decision-making, because it has dual objectives from a payor’s point of view. Although the move of payors and providers toward patient-centeredness may be somewhat selfish, greater patient (and caregiver) engagement is of supreme importance to one’s own protection and safety.
Too many patients currently still must confront surgical outcomes that fail to meet their expectations for treatment of stress urinary incontinence (SUI) and pelvic organ prolapse (POP), dissuading others by word-of-mouth from seeking diagnosis, much less treatment. Fragmentation, competition, and disagreement among providers as to standard protocols for treatment of SUI and POP still remain. Providers continue to lack experience and/or sufficient surgical training for treating SUI and POP, resulting in misdiagnosis, misinformation to the patient, poor patient selection for certain procedures, and ultimately the need for costly, repeat surgeries, intervention for correcting adverse events, and the search by patients for second opinions.
In this environment, the NAFC is applying a patient-centered discipline to its process of designating Centers of Excellence (COE) in Continence Care. The NAFC distinguishes its COE designation process from those led by medical societies and entities with commercial interests. As opposed to being physician-centered or hospital-driven, the NAFC’s entire process is first and foremost patient-centered with an overarching focus on assessing patient satisfaction. In addition, the NAFC’s benchmark based on patient satisfaction ratings is dynamic and continually evolving with every applicant. Also, rather than structured around a single physician specialty with a “silo” mentality, the NAFC’s assessment is comprehensive and multidisciplinary and includes all team members — ie, doctors, nurses, physical therapists, and administrative staff.
The NAFC actively promotes COEs with a distinguishable logo, news releases, website coverage, and online links. Unlike some provider initiatives, the NAFC has no commercial interest in mining and marketing its data on patients, nor does it have international expansion interests. Our mission remains US-based, as it has been for 30 years.
The NAFC is eager to direct consumers seeking experts in continence care to make sound choices in providers. Stay in tune to patient-centered healthcare initiatives, but remain on guard for “look-alikes.”
The National Association For Continence is a national, private, non-profit organization dedicated to improving the quality of life of people with incontinence. The NAFC’s purpose is to be the leading source for public education and advocacy about the causes, prevention, diagnosis, treatments, and management alternatives for incontinence. This article was not subject to the Ostomy Wound Management peer-review process.
1. http://www.pcori.org/about. Accessed December 26, 2011.
2. http://evidencebasedhealthcare.org/index.cfm?objectid=7FAB5952-1372-4D20-C8E06EB05333EBBA Accessed December 26, 2011.
3. Mathews AW. The future of U.S. healthcare, The Wall Street Journal. December 12, 2011.
