“It’s about embracing the inscrutable nature of human interactions,” says Chang. Evidence-based medicine was a massive improvement over intuition-based medicine, he says, but it only covers traditionally quantifiable data, or those things that are easy to measure. But we’re now quantifying information that was considered qualitative a generation ago.

“Our biggest opportunity is leaning into that. It’s either embracing the qualitative nature of that and designing systems that can act just on the qualitative nature of their experience, or figuring how to quantitate some of those qualitative measures,” says Chang. “That’ll get us much further, because the real value in health care systems is in the human interactions. My relationship with you as a doctor and a patient is far more valuable than the evidence that some trial suggests.”

Duffy points to the increase in health care interactions online and adds that he would like to see a pervasive culture of in-person care as last resort. “If every organizational decision, technology decision, process decision — assuming all the payment stuff, that’s kind of ticket of entry, transpires — if you view in-person as last resort, that will help pull systems across the country to a more consumer-forward Uber-like experience,” he says

As with other forms of value-based health care, patient-centered care requires a shift in the way provider practices and health systems are designed, managed, and reimbursed. In keeping with the tenets of patient-centeredness, this shift neither happens in a vacuum, it driven by traditional hierarchies in which providers or clinicians are the lone authority. Everyone, from the parking valet and environmental services staff to c-suite members, are engaged in the process, which impacts hiring, training, leadership style, and organizational culture. Patient-centered care also represents a shift in the traditional roles of patients and their families from one of passive “order taker” to one of active “team member.” One of the country’s leading proponents of patient-centered care, Dr. James Rickert, has stated that one of the basic tenets of patient-centered care is that “patients know best how well their health providers are meeting their needs.” To that end, many providers are implementing patient satisfaction surveys, patient and family advisory councils, and focus groups, and using the resulting information to continuously improve the way health care facilities and provider practices are designed, managed, and maintained from both a physical and operational perspective so they become centered more on the individual person than on a checklist of services provided. As the popularity of patient- and family-centered health care increases, it is expected that patients will become more engaged and satisfied with the delivery of their care, and evidence of its clinical efficacy should continue to mount.

The concept of patient-centered care extends to the treatments and therapies clinicians provide. Not only are care plans customized, but medications are often customized as well. A patient’s individual genetics, metabolism, biomarkers, immune system, and other “signatures” can now be harnessed in many disease states — especially cancer — to create personalized medications and therapies, as well as companion diagnostics that help clinicians better predict the best drug for each patient.

Strict visiting hours and visitor restrictions are a thing of the past in a patient-centered care model. Patients are given the authority to identify who can visit and when. Family members (as defined by the patient and not limited to blood relations) are invited to visit during rounding and shift changes so they can be part of the care team, participating in discussions and care decisions. When not in the room with the patient, they are kept informed of their loved one’s progress through direct and timely updates. A patient-centered care hospital’s infrastructure encourages family collaboration through a home-like environment that not only meets the needs of the patient, but also meets the needs of family members. For example, maternity wards are being redesigned with family-friendly postpartum rooms that can accommodate the mom, new baby, and family members, who are encouraged to spend up to 24 hours a day together in the room to foster family bonding.

The primary goal and benefit of patient-centered care is to improve individual health outcomes, not just population health outcomes, although population outcomes may also improve. Not only do patients benefit, but providers and health care systems benefit as well, through: Improved satisfaction scores among patients and their families. Enhanced reputation of providers among health care consumers. Better morale and productivity among clinicians and ancillary staff. Improved resource allocation. Reduced expenses and increased financial margins throughout the continuum of care.

Patient- and family-centered care encourages the active collaboration and shared decision-making between patients, families, and providers to design and manage a customized and comprehensive care plan. Most definitions of patient-centered care have several common elements that affect the way health systems and facilities are designed and managed, and the way care is delivered: The health care system’s mission, vision, values, leadership, and quality-improvement drivers are aligned to patient-centered goals. Care is collaborative, coordinated, and accessible. The right care is provided at the right time and the right place. Care focuses on physical comfort as well as emotional well-being. Patient and family preferences, values, cultural traditions, and socioeconomic conditions are respected. Patients and their families are an expected part of the care team and play a role in decisions at the patient and system level. The presence of family members in the care setting is encouraged and facilitated. Information is shared fully and in a timely manner so that patients and their family members can make informed decisions.

In patient-centered care, an individual’s specific health needs and desired health outcomes are the driving force behind all health care decisions and quality measurements. Patients are partners with their health care providers, and providers treat patients not only from a clinical perspective, but also from an emotional, mental, spiritual, social, and financial perspective.

Koh et al. (11) detailed a cycle of crisis care elaborating the nature of high medical costs, possibly resulting from fear and denial. First, an individual is in need of medical help, so he or she goes to a physician's office where the staff asks the individual to fill out a complex and confusing form. The physician examines the patient and explains the condition and treatment options using medical jargon. Numerous prescriptions, laboratory tests, and referrals are given without confirmation of the patient's comprehension. The staff sends the patient home with complicated instructions. Inevitably, the patient may consume medication incorrectly or miss follow-up appointments, and his or her condition worsens. Eventually, the patient presents to the emergency department, and the hospital staff develops a new treatment plan. Again, no one confirms the patient's understanding. When the patient is discharged, he or she is likely to get sick again and repeat the cycle (11)

Making Child Care More Accessible and Affordable

We want better children—but not by turning procreation into manufacture or by altering their brains to gain them an edge over their peers. We want to perform better in the activities of life—but not by becoming mere creatures of our chemists or by turning ourselves into tools designed to win or achieve in inhuman ways. We want longer lives—but not at the cost of living carelessly or shallowly with diminished aspiration for living well, and not by becoming people so obsessed with our own longevity that we care little about the next generations. We want to be happy—but not because of a drug that gives us happy feelings without the real loves, attachments, and achievements that are essential for true human flourishing.

medical care

child care

Child and elder care

The technical and theoretical details underlying clinical informatics are beyond the scope of this chapter. What follows is a concise introduction to topics and resources of general interest in this field, presented to help clinicians use information technology for the benefit of patient care.

Satisfaction with cost to you88.93

Convenience of location for you84.17

Friendliness and courtesy of the staff78.63 High

Accuracy and completeness in filling out reports73.66

Skill and competency of medical staff

Speed in completing examination and reports

There are many resources available to help you and your health care proxy develop a care plan. These are merely suggestions to get you thinking about possible scenarios and topics to discuss. I hope you found this blog informative, and urge you to share it with anyone who does not have a health care proxy. We always think it will never happen to us, but what if it does? It's best to be prepared!

Further, a doctor, medical center, hospital, EMT, and even assisted living staff can make decisions regarding your healthcare, treatment methods and type of medical care to provide you if you are not married, over 18 years old, and do not have a health care proxy in place

Who would decide what was best for you? Who would advocate on your behalf?

Health care proxy: An advance medical directive in the form of a legal document that designates another person (a proxy) to make health care decisions in case a person is rendered incapable of making his or her wishes known.

The question each proxy should ask when making decisions on behalf of others is, who am I truly serving — the patient or myself?

When the patient is unwilling or unable to make medical decisions, the health care proxy is activated and he or she is obligated to make all health choices on behalf of the patient. These may be related to withdrawing or withholding life support, instituting artificial liquid feeding, attempting resuscitation and even whether or not to participate in autopsy and organ donation.

First, the industry is demanding it. Those who are paying for healthcare—the government, employers, patients, commercial health plans—want more value for their healthcare dollar. The transaction-driven, fee-for-service model has helped contribute to a fragmented healthcare system that has led to major challenges in healthcare. This fee-for-service model is simply not sustainable.

reliability and accessibility of big data will help facilitate increased reliance upon outcomes-based contracting and alternative payment models.

fee-for-service payment models to value-based care

He calls for more thoughtful engagement with the notion not so much of making things, but of fixing them, repurposing them in their diminishment and dismantlement—not of making new, but of making do, and of thereby engaging what he calls ‘an ethics of mutual care’—with each other, the world around us, and with the (quite literal) objects of our affection (Jackson, 2013, p. 231). This is a source, he says, of ‘resilience and hope’ and it’s a way of being in space and time that has deep feminist roots (Jackson, 2013, p. 237).

‘I don’t care about me.’

Section 139A of the Internal Revenue Code of 1986 is amended by adding at the end the following new sentence: “This section shall not be taken into account for purposes of determining whether any deduction is allowable with respect to any cost taken into account in determining such payment.”.

Es handelt sich um eine Politik ohne Zwang, die biopolitische Interessen in die Individuen hineinverlagert. Der gesellschaftliche Zugriff auf den weiblichen Körper bleibt bestehen, es sieht aber nach Freiheit aus, argumentiert wird mit "optimalen Gesundheitsentscheiden" oder "Risikominimierung". Dieser individualisierte Optimierungsimperativ macht es letztendlich schwierig zu erkennen, dass Kinderbekommen kein privates Ereignis ist, sondern auch Teil von gesellschaftspolitischen Dynamiken. Auf diese Weise wird auch das große Thema Care-Arbeit ausgeblendet.

The science of variation like the clinical gaze was believed to unearth all sides of truth and was therefore effectively applied as a form of industrial management in order to cope with population growth.

that doesn't mean the drugs can't be immensely profitable. Treanda is an orphan drug but also Teva's second-best seller, racking up $740 million in sales last year, according to Teva's annual report.

Is Google Making Us Stupid?

Show

Or more plainly: attention on social media both compensates for and is the logical endpoint of commoditized care work.

The disaggregation of news in the Internet age has inverted this relationship, and made news outlets hypersensitive to the interests of their readers. This is a positive development. It’s good that the media covers stories that its constituents are interested in and want to read about. It’s good when news outlets are connected to the communities they serve.

we feel friendly to those who have treated us well, either ourselves or those we care for, whether on a large scale, or readily, or at some particular crisis; provided it was for our own sake.