Echo L. Warner MPH
PhD Student, University of Utah College of Nursing
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History
of PCR: Healthcare has been informed, historically, by empirical evidence-based
medicine. Evidence-based medicine is focused on clinical guidelines, protocols,
and best practices that are identified using population based approaches (i.e.,
the best approach for the biggest group of people) (Romana, 2006). However, a paradigm shift has occurred over
the last few decades as healthcare providers and administrators have begun to
realize the integral nature and value of patient centered care. In contrast to
evidence-based medicine, patient centered care and research prioritizes the
voice of the patient and supports clinical discretion (Romana, 2006). Dr. John
Noble first described the need for patient centered research (PCR) in 1989
(Noble, 1989). Noble (1989) described PCR as an approach to discovering new
knowledge and identifying strategies to improve the patient experience by
engaging patients and clinicians in the study of the social, psychological, and
individual factors that influence the healthcare experience (Noble, 1989).
PCORI PCR Focused Funding Announcements
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Funds Available
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Application Dates
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$18 million
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9/30/2015
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$12 million
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11/3/2015
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Varies
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10/1/2015
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Example of PCR:
In
an effort to provide the best and most appropriate patient centered care there
has become an increasing focus on PCR over the last few decades. In 2010, the
Obama administration devised the Patient Centered Outcomes Research Initiative
(PCORI), in an effort to allocate funding toward studying what kind of healthcare
is most effective for certain patients. PCORI also prioritized four domains of
research: improving healthcare systems, communication and dissemination, health
care disparities, and accelerating patient-centered and methods research (Sox,
2012). Specifically, the goal of this priority is to develop an informed
community of patients, a focus on patient preferences, and development of
innovative methodologies that engage and emancipate patient perspectives to
improve the healthcare experience (Sox, 2012). A major focus of PCR is patient
involvement from conception and design of a study throughout interpretation and
dissemination. PCR focuses on questions and outcomes that matter to patients. Currently
the PCORI initiative is engaged in funding innovative PCR. Examples of funded
PCR studies are described on the PCORI website. In an effort to adhere to their
mission of patient centeredness, PCORI also publishes a public
blog
encompassing a
range of topics from new funding announcements to research results (Table 1). PCORI is one example
of the burgeoning new research that is patient-centric and that aims to improve
the patient experience from birth through death.
Challenges of PCR: It has yet to be
examined whether and how PCR improves upon prior research approaches. In other
words, research is needed that measures the effectiveness, cost-efficiency, and
ultimately the power of PCR to change patient experiences while still
preserving utmost clinical care. That being said, similar to other research
methods and frameworks, PCR has its drawbacks. Challenges to conducting PCR include foundational
differences between researchers and patients including focusing on outcome
metrics that are not prioritized among both groups equally, limited and
differing availability and desire to engage in PCR, and language barriers
(Perez, 2013). Moreover, unintended consequences of PCR such as unequal power
relations between researchers and patients may limit the depth and breadth of PCR.
Lastly, the long-term impact of PCR is unknown. Additional research is needed
to more fully understand the practical application of PCR and how this type of
research approach influences patient care.
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| Photo courtesy of the CDC |
Future
Directions: In his
TEDx talk at the University of Minnesota, The Future of Patient-Centered Care, Dr. Dave Moen, MD describes his journey from working
as an emergency medicine physician to rediscovering the value of patient
centered care while caring for victims of domestic violence. Like Dr. Moen, as
healthcare professionals and researchers, we are all on a journey to understand
the future of patient centered care, and the PCR that will ultimately guide the
implementation of this care. In the future, we can undoubtedly learn more by
exploring new research methodologies that extend beyond the bounds of
evidence-based medicine. In other words, by directly involving patients in PCR,
we may be more fully able to improve the patient centered care experience.
While the transition from evidence-based medicine
to patient centered care represents an evolving change in the way that
healthcare providers and patients make decisions, we are still left with
unanswered questions about PCR.
References and Additional Recommended
Links:
Noble
J. Patient-centered Research: Through the Looking Glass in Search of a
Paradigm. Journal of General Internal
Medicine. 1989;4:555-557.
Perez
B, Cummings L, Schrag J, Mead H, Jewers M. Facilitators and Barriers to Providing Patient-Centered Chronic Disease
Care to Patient Populations at Risk for Health and Health Care Disparities in
Safety Net Settings. America’s Essential Hospitals. 2013.
Romana
H. Is Evidence-Based Medicine Patient-Centered and Is Patient-Centered Care
Evidence-Based? Health Services Research.
2006;41(1):1-8.
Sox
H. The Patient-Centered Outcomes Research Institute Should Focus on High-Impact
Problems That Can Be Solved Quickly. Health
Affairs. 2012;31(10):2176-2182.
This work is by Echo Warner is licensed
under a Creative Commons Attribution 4.0 International
License
