Commentary: Refining the definition, delivery of 'person-centered care'

Aside from being healthcare providers, many of us also find ourselves in the role of family caregivers, experiencing the seemingly great divide between how the medical system sets a patient's goals and what that same patient seeks in daily life. We also might know this from being patients ourselves.

The medical system typically measures success as decreasing the negative effects of disease, while patients focus more on when and how they can get back to their daily routines. Sometimes these goals match up; often they don't. Ask any person what “being well” looks like and they're likely to talk about being able to function in spite of disease, rather than how they are dealing with symptoms or side effects of multiple treatments. This difference is especially stark for older adults with complex health problems, who often have a limited say in how they are treated by a network of well-meaning primary-care clinicians, specialists, hospitalists, and family members pushing their own points of view about “success.”

How do we better connect with each patient as a person within the realities of our current healthcare system?

An expert panel recently convened by the American Geriatrics Society (AGS) and funded by The SCAN Foundation, focused on this question by helping to define person-centered care—a treatment approach most of us strive for and want to practice, but one that's hard to act on without clarity on what it means and entails.

Putting people at the center of their care may seem obvious—even intuitive—but it's ironically a concept that the healthcare community is still deciphering. Despite a sizable and growing body of evidence on the value of person-centered care, and frequent inclusion of the term in health policy and research, there is still no standard, agreed-upon definition. For this reason, the AGS panel sought the root of what we mean when we talk about a person-centered approach.

Based on a comprehensive literature review and qualitative interviews, the expert panel reviewed how person-centered care has been defined and put into practice thus far, and what is needed to make the term more succinct and actionable. The group convened thought leaders in aging to clarify both the definition of person-centered care and essential elements of that care-delivery approach.

The panel defined person-centered care as “care in which individuals' values and preferences are elicited and, once expressed, guide all aspects of their healthcare, supporting their realistic health and life goals.”

The experts identified eight characteristics of person-centered care:

• An individualized, goal-oriented care plan based on the person's preferences.
• Ongoing review of the person's goals and care plan
• Care supported by an interprofessional team in which the person is an integral team member
• One primary or lead point of contact on the healthcare team
• Active coordination among all healthcare and supportive-service providers
• Continual information sharing and integrated communication
• Education and training for providers and, when appropriate, the person and those important to the person
• Performance measurement and quality improvement using feedback from the person and his/her caregivers

Person-centered care starts with gathering information about the person's needs, values and preferences—in the context of his/her medical and functional needs—with input from those they wish to include, such as family or friends. Rather than being driven by purely clinical outcomes, this information is used to help the person shape and articulate specific and measurable goals that help form a care plan in sync with how the person wants to live.

We now live and work in a healthcare system that recognizes how valuable a team can be to care delivery—and the future of person-centered care is no exception. In many respects, person-centered care helps take the team model one step further by encouraging providers and patients to work together to develop an action plan that meets the person's daily living goals, rather than one based on medical interventions the person may not want.

Perhaps not surprisingly, when care is matched with patients' goals, they usually get the right support at the right time by the right providers at an efficient cost. All of this fosters health services that are respectful and responsive, helping us cross the divide between what people want and need from their care and how our healthcare system responds.

Nancy Lundebjerg is CEO of the American Geriatrics Society. Dr. Bruce Chernof is president and CEO of the SCAN Foundation.