What are key considerations for delivering great medical care?

Key Considerations for Delivering Great Medical Care

The delivery of great medical care requires a patient-centered approach that is safe, effective, timely, efficient, equitable, and respectful of individual patient preferences, needs, and values to ensure optimal health outcomes. 1

Core Principles of Quality Healthcare

Patient-Centered Care

• Provide care that is respectful and responsive to individual patient preferences, needs, and values, ensuring patient values guide all clinical decisions 1
• Engage in explicit and collaborative goal setting with patients to improve adherence and outcomes 1
• Assess patient health literacy using tools like the Rapid Estimate of Adult Literacy in Medicine to tailor communication appropriately 1
• Evaluate patients' computer and mobile device literacy to determine their ability to use electronic health resources 1

Safety

• Avoid injuries to patients from care that is intended to help them 1
• Implement electronic health record tools linked to clinical guidelines to reduce avoidable medical errors 1
• Recognize that preventable medical errors are a leading cause of death, with significant financial and trust implications 1

Effectiveness

• Provide services based on scientific knowledge to all who could benefit while refraining from providing services to those not likely to benefit 1
• Avoid therapeutic inertia by prioritizing timely and appropriate intensification of behavior change or pharmacologic therapy 1
• Integrate evidence-based guidelines and clinical information tools into the process of care 1

Multidisciplinary Team Approach

Team Composition

• Implement care teams that include nurses, dietitians, pharmacists, and other providers to optimize patient outcomes 1
• For complex conditions like diabetes, utilize a diverse team with complementary expertise to address the pluralistic needs of patients 1
• Engage multidisciplinary expertise including medical specialists, surgical specialists, radiation specialists, and palliative care experts when appropriate 1

Team Function

• Avoid therapeutic inertia by prioritizing timely and appropriate intensification of therapy for patients who haven't achieved recommended targets 1
• Incorporate care management teams to improve health outcomes and catalyze reductions in clinical parameters like A1C, blood pressure, and LDL cholesterol 1
• Implement the Chronic Care Model (CCM) which has been shown to improve quality of care through system redesign, self-management support, decision support, and clinical information systems 2

Addressing Social Determinants of Health

Financial Considerations

• Understand that cost of medications and devices is an ongoing barrier to achieving clinical goals 1
• Recognize that up to 25% of patients prescribed insulin report cost-related medication underuse 1
• Assess patients' socioeconomic status by asking direct questions like "Do you have difficulty paying for any of your medications or healthcare services?" 1
• Remove financial barriers and reduce patient out-of-pocket costs for education, monitoring, and necessary medications 2

Support Systems

• Evaluate family and other support systems by understanding whom patients live or frequently interact with and their relationships 1
• Assess the physical environment including home safety, access to adequate nutrition, transportation, and facilities for exercise 1
• Consider outside-of-family professional care when patients' needs create an unsustainable burden on family caregivers 1

Improving Healthcare Delivery Systems

System Design

• Redesign care processes to move from reactive to proactive care delivery systems 2
• Implement the Patient-Centered Medical Home model which shows promise for improving health outcomes by fostering comprehensive primary care 1
• Adopt the six rules for healthcare redesign from the Institute of Medicine, including basing care on continuous healing relationships and customizing care according to patient needs 1

Quality Improvement

• Implement quality improvement programs combining continuous quality improvement cycles with provider performance data 1
• Use checklists that mirror guidelines to improve adherence to standards of care 1
• Provide automated reminders to healthcare professionals and patients, and report process and outcome data to providers 1

Communication and Shared Decision Making

Effective Communication

• Identify and address language, numeracy, or cultural barriers to care 1
• Recognize that effective physician-patient communication is essential to individualize care, prioritize among multiple needs, and elicit goals to improve patient engagement 3
• Ensure patients have access to their medical records and that providers are available to explain the contents 1

Shared Decision Making

• Empower patients to participate in decision making about their treatment and care to the degree they desire 1
• Provide patients access to a second opinion and the ability to choose among different treatments and providers 1
• Recognize that patient-centered care requires health care organizations and professionals to actively understand what patients value 4

Common Pitfalls to Avoid

• Failing to assess health literacy, which can lead to misunderstanding and non-adherence to treatment plans 1
• Ignoring cost considerations, which can result in cost-related medication non-adherence and poorer outcomes 1
• Fragmented care systems that lack clinical information capabilities, duplicate services, and are poorly designed for chronic care delivery 1, 2
• Focusing solely on clinical aspects while neglecting psychosocial contexts that significantly impact health outcomes 1
• Allowing therapeutic inertia to prevent timely intensification of treatment when targets aren't being met 1