Measuring Patient-Centeredness In Patient-Provider Interactions in VHA

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Delivering patient centered care is critical to the VA's mission. To foster this mission the VA established the Patient Aligned Care Teams (PACT) and the Office of Patient Centered Care and Cultural Transformation (OPCCCT). Patient centered care is "person-focused, proactive, lifelong and partnership based to optimize health and well- being." Patient centered care has been shown to be beneficial for health outcomes and patient satisfaction. One key aspect of patient-centered care is the quality of provider- patient interaction, which includes treating the patient with dignity and respect, adequate information sharing, encouraging participation and collaborative decision-making. Despite the importance of this topic, providers have been slow to adopt these changes. Understanding the provider's perspectives, information needs and strategies for incorporating a patient-centered approach is key to effective implementation. Older patients are more likely to have complex medical histories, undergo multiple transitions of care, face additional risk from treatments, and have age-based differences in the desire to participate in patient centered care (PCC) processes. We propose to identify provider's mental models, expectations, and goals for delivering patient centered care. To do this, we will conduct cognitive work analyses with 10 clinicians at the Salt Lake City VA. In addition, we will conduct observations of patient visits with 10 clinicians at each of four sites (total 40 providers; 40 observations). Patient visits will be videotaped and a subsequent interview will be conducted. Patient perspectives on these visits will also be examined in post-observation interviews. We also propose to characterize provider perspectives on patient centered care by using a Q-sort method to understand typologies of provider views and strategies used to deliver care. Results from this pilot proposal will lay the foundation for a program of research into patient-centered care that integrates PCC strategies and information components using sociotechnical approaches. The VA is uniquely poised to conduct this line of research as it is currently implementing a medical home model across the nation, has extensive experience with the electronic medical record and has made an institutional commitment to patient centered care. This pilot will lead to IIRs that test decision support interventions, educational programs and new metrics for measurement in the domain of patient centered care.