Crain's Detroit Business Print Version
May 30, 2014
Traditional health care delivery starts with a patient complaint or injury, a medical evaluation and then a treatment plan.
But research just underway at Henry Ford Health System in Detroit could lead to more patient or family involvement before a physician recommends treatment.
"There is a lot of work out there saying patients should be partners with physicians and make decisions together for their health care, but some patients don't want to be partners. They want the physician to tell them what to do," said Christine Cole Johnson, new director of Henry Ford's Center for Patient-Centered Outcomes Research.
On the other hand, Johnson said, a growing number of patients want to make their own treatment decisions or work with physicians to develop a customized plan that fits their needs.
"We need to figure out ways to help physicians find out what patients want, and give them care that way," said Johnson, an epidemiologist who also is chairwoman of the system's department of public health sciences.
Johnson said one of the main practical goals of the Henry Ford research will be to provide physicians, advanced practice nurses and other providers with information on how to discover patient preferences. These preferences need to be identified on the level that the patient wants to be involved in their care.
Created by a five-year, $5 million grant from the federal Agency for Healthcare Research and Quality, Henry Ford's new patient outcomes center will study ways to improve patient interactions in three areas: childhood obesity and asthma and hysterectomies.
Beyond the agency grant, Johnson said Henry Ford's center will also look at developing other research projects to aid patients and health care professionals in understanding which prevention strategies and treatments are best.
Johnson said the center initially will hire two employees—a project executive and an information technology staffer—to oversee the studies. Other part-time researchers, along with physicians, nurses, home health and nursing home professionals, will assist in the projects, she said.
The center also will work with a number of faith-based and community organizations to provide feedback on the studies and seek volunteers to become part of the research.
The participating organizations are the Detroit-based Brightmoor Alliance, Chadsey-Condon Community Organization, Fit Foundation of America, Health Alliance Plan, Interfaith Health & Hope Coalition, Osborn Neighborhood Alliance and Southwest Solutions; Corinthian Missionary Baptist Church in Hamtramck; Gethsemane Baptist Church in Westland; and the University of Michigan.
"We want to talk with the community leaders, invite them in for meals and create a pool of people who are interested" in the pilot studies, Johnson said.
Henry Ford is one of seven organizations, and the only one in Michigan, to receive the $5 million federal grants to study ways to improve women and children's health, reduce health disparities and enhance patient outcomes.
Over the past decade, physicians have become more sensitive to the wishes of patients to become more involved, said Mary Durfee, M.D., chief medical officer with Ann Arbor-based IHA, a 150-physician multi-specialty medical group.
"This movement toward more patient-centered care has been going on for seven or eight years," Durfee said. "This is the next step (in Henry Ford's research). Many of us put patients on various committees and get their opinions on best care approach."
Durfee said many physicians, including those at IHA who practice under the patient-centered medical home model, already try to find out patient goals for their care and collaborate on treatment plans. Patient-centered medical homes shift to primary care providers the responsibility for coordinating the complete health and social care needs of their patients in a comprehensive health management model.
"Patients who participate with their doctors are definitely more compliant (in their treatment plan) and have better outcomes," she said.
Denver Health, a Colorado-based integrated public health system, also has been funded by the federal agency to study ways to improve patient outcomes, said Ed Havranek, M.D., Denver Health's director of health services research.
As with Denver Health's grant, the Henry Ford research will provide good feedback to physicians on ways to improve quality and primary care preventive services.
"Most medical care doesn't start asking patients what they want for their care," said Havranek, a practicing cardiologist. "We should be asking patients, 'What is important? What is meaningful to you? What do you perceive as being important from your care?' "
Denver Health's three pilot projects will attempt to show how to move care outside the walls of the six federally qualified health centers that the system operates, Havranek said.
One study, for example, will transmit text messages to 160 pre-diabetic patients to remind them of proper diets. Responses from the group will be tracked and medical care closely monitored for improvement.
"The theory is people who come to health classes once a week do better because they eat better," Havranek said. "We have broken the instruction into text messages. We are delivering the same content as the classes."
Havranek said engaging patients in their own care is difficult because modern medical care has become very technical and is less easily understood.
For example, he said, patients could choose chemotherapy to treat cancer.
"Chemotherapy might prolong life, but it could diminish the quality of remaining life," Havranek said. "Physicians focus on the former and de-emphasize the latter. Usually (chemotherapy) is the right thing to do, but that isn't always what patients and families want."
Havranek said knowing upfront what type of conversation to have with your patient can help patients and doctors make decisions.
"Most conversations between physicians and patients are vague, and very abbreviated," he said. "It is me telling you what I want, and not eliciting values from you."
Henry Ford pilot studies
The same kind of decision tree can apply at the other end of the health spectrum with medical treatment options for children. Childhood obesity and asthma pose significant problems for parents and providers because children are very sensitive to peer or authority pressure, Johnson said.
"Pediatricians address issue of obesity in children, but they don't always know how to do it because it is a sensitive issue," Johnson said. "Doctors don't always know if parents want them to talk with their children about it, so we are trying to develop a decision aid, a paper, that helps them" to advise patients on medication and diet issues.
For women facing hysterectomy surgery, Johnson said, the wide variety of methods for removing the uterus can lead to multiple options. Properly educating patients means explaining the pluses and minuses for each technique.
Typically, hysterectomies are either traditional open surgery with wide-open incisions or minimally invasive procedures that include robotic or laparoscopy techniques.
"Depending on the choices, they are all related to blood loss for patients and length of recovery and scarring," said Johnson, adding: "This is all about improving outcomes to make medicine more effective—and trying to make the practice of health care more effective for patients, providers, parents and physicians."
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