Authors' recommendations: Patient-centered care can be a nebulous concept with a range of definitions and acknowledged difficulty in measuring it or its effects. Hence, investigators approaching the concept have tended to break it down into more manageable segments, such as the efficacy of self-management education programs for patients with chronic diseases. Other component concepts of patient-centered care operationalized as interventions inevitably have followed the same path; most reviews identified for this overview synthesized disease-specific patient education or self-management interventions. Systematic reviewers of these segments consistently identified methodologic shortcomings, inconsistent efficacy results, and heterogeneity among studies that precluded meta-analysis. Patient-centered care overallSystematic reviews were synthesized primarily for chronic conditions, but no review focused explicitly on all aspects of patient-centered care as outlined in the PCS strategic planning initiative group’s definition, and only one review attempted any breadth of approach (Lewin, 2001).Compelling reasons, such as the ethics of promoting patient autonomy, may argue for adoption of patient-centered care, but most systematic reviews found available research lacking in quantity or quality adequate to provide definitive answers on effectiveness of interventions classifiable as patient-centered. Reviewers generally agree that there seems to be some evidence that the patient-centeredness, as an end in itself, along with intermediate outcomes such as knowledge or adherence to treatment, can be enhanced, although any impact on health status remains uncertain. Lewin (2001) provides a still valid conclusion for patient-centered care:“Even if the processes of patient-centered care can be regarded as desirable in their own right, reliable assurance that they result in more good than harm should be sought. As with many other complex interventions in health care, evidence of effectiveness, or lack thereof, is still needed.” Communication with patients/patient educationReviews of communication or patient education cover a broad range of interventions and they found areas of consensus across that range: The quality of primary research needs improvement; Articles meeting selection criteria for individual reviews used patient populations, interventions, and outcomes too heterogeneous to pool results; Any positive effects were small relevant to intermediate outcomes, or seen only in some diagnostic groups at some follow-up periods.Finally, as the PCS strategic planning initiative group proceeds and further clarifies its literature synthesis needs, TAP will continue to monitor the literature for new approaches to defining and measuring patient-centered care. While isolated RCTs (notably those from UK’s Expert Patients Program (Kennedy 2007), Table 2) provide models for trial design and reporting, the limited number of review-eligible new RCTs (Table 3) present neither dramatically improved methods, nor definitive evidence for the impact of patient-centered care on health status. Searches of ongoing trials (conducted 8/19/2010 at www.clinicaltrials.gov) did not identify breakthrough research likely to change the overall status of the evidence base in the foreseeable future.

Project Status: Completed

URL for project: http://www4.va.gov/VATAP/docs/Patientcenteredcare2010.pdf

Year Published: 2010

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: VA Technology Assessment Program

Contact Address: Liz Adams, VA Technology Assessment Program, Office of Patient Care Services (11T), VA Boston Healthcare System Room 4D-142, 150 South Huntington Avenue, Boston, MA 02130 USA Tel: +1 617 278 4469; Fax: +1 617 264 6587;

Contact Name: elizabeth.adams@med.va.gov

Contact Email: elizabeth.adams@med.va.gov

Copyright: VA Technology Assessment Program (VATAP)