Personalized Strategies to Activate and Empower Patients in Health Care and Reduce Health Disparities
Personalized Strategies to Activate and Empower Patients in Health Care and Reduce Health Disparities
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DOI：
10.1177/1090198115579415
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发表时间：
2016-02-01
影响因子：
4.2
通讯作者：
Thomas, Stephen B.
中科院分区：
文献类型：
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作者：
Chen, Jie;Mullins, C. Daniel;Thomas, Stephen B.
设计对文化敏感的个性化干预措施对于维持患者参与治疗并鼓励患者在自己的健康和保健中发挥积极作用至关重要。我们认为，患者的激活和赋权是一个循环的过程，通过患者积累知识、自信和自我决定自己的健康和医疗保健。我们提出了一个以患者为中心的、多层次的激活和赋权框架(个人、医疗保健专业人员、社区和医疗保健提供系统级别)，以促进文化信息个性化患者激活和赋权(P-PAE)干预措施的发展，以改善人口健康并减少种族和民族差异。我们讨论了相关的《平价医疗法案》支付和交付政策改革，以及它们如何影响患者的激活和授权。这些政策包括责任关怀组织和基于价值的购买、以患者为中心的医疗机构和社区健康福利。讨论了实施P-PAE的挑战和可能的解决方案。需要具有一致的P-PAE措施的综合和纵向数据集来进行比较有效性分析，以评估最优的P-PAE模型。我们相信，P-PAE模式是及时和可持续的，对于让患者参与治疗、发展患者管理健康的能力、帮助患者表达对治疗的担忧和偏好、使患者能够就治疗方案提出问题以及通过共同决策建立战略患者-提供者伙伴关系至关重要。
Designing culturally sensitive personalized interventions is essential to sustain patients' involvement in their treatment and encourage patients to take an active role in their own health and health care. We consider patient activation and empowerment as a cyclical process defined through patient accumulation of knowledge, confidence, and self-determination for their own health and health care. We propose a patient-centered, multilevel activation and empowerment framework (individual-, health care professional-, community-, and health care delivery system-level) to inform the development of culturally informed personalized patient activation and empowerment (P-PAE) interventions to improve population health and reduce racial and ethnic disparities. We discuss relevant Affordable Care Act payment and delivery policy reforms and how they affect patient activation and empowerment. Such policies include Accountable Care Organizations and value-based purchasing, patient-centered medical homes, and the community health benefit. Challenges and possible solutions to implementing the P-PAE are discussed. Comprehensive and longitudinal data sets with consistent P-PAE measures are needed to conduct comparative effectiveness analyses to evaluate the optimal P-PAE model. We believe the P-PAE model is timely and sustainable and will be critical to engaging patients in their treatment, developing patients' abilities to manage their health, helping patients express concerns and preferences regarding treatment, empowering patients to ask questions about treatment options, and building up strategic patient-provider partnerships through shared decision making.