Inappropriate health care is an escalating and expensive problem. It affects high income, middle income, and low income countries and wastes billions of dollars annually as well as harming individuals and communities. Inappropriate care refers to both the overuse and underuse of tests and treatments and, ironically, can occur concurrently within the same health system. Even though patient-centred care is still the prevailing ethos, specifying where patients should be situated geographically has not required health professionals to consider the preferences, values, and priorities of patients when making treatment decisions. Patient-perspective care demands that the decisions health professionals make are in the service of patient’s goals. Health care, ultimately, is helping individuals to live the lives they would wish for themselves. In order to meet this imperative, health professionals must work towards understanding what their patients would like to achieve through their engagement with health services. This book details the extent and scope of inappropriate care and how we have arrived in this position. The necessity for patient-perspective care is outlined and provides a theoretical framework that explains why patient-perspective care is so critical. The implications of this theory are then explored and specific strategies for moving towards a patient-perspective approach are discussed. This book is entirely original and describes a novel, fresh approach to delivering health services. Many long-standing and expensive problems such as missed appointments will disappear and patients will be more satisfied with the treatments they receive. Health services generally will be more efficient and effective leading to more sustainable and affordable health care.

This book brings together world-class figures to provide an indispensable, comprehensive resource book on social science, health and medicine.

Sponsored by the Picker/Commonwealth Program for Patient-Centered Care In this comprehensive, research-based look at the experiences and needs of patients, the authors explore models of care that can make hospitalization more humane. Through the Patient's Eyes provides insights into why some hospitals are more patient-centered than others; how physicians can become more involved in patient-centered quality efforts; and how patient-centered quality can be integrated into health care policy, standards, and regulations. The authors show how, by bringing the patient's perspective to the design and delivery of health services, providers can improve their ability to meet patient's needs and enhance the quality of care.

The evidence is undeniable. By any measure, the US spends more on healthcare than any other country in the world, yet its health outcomes as measure by longevity are in the bottom half among developed countries, and its health-related quality of life has remained constant or declined since 1998. In addition to high costs and lower than expected outcomes, the healthcare delivery system is plagues by treatment delays as it can take weeks to see a specialist, and many people have limited or no access to care. Part of the challenge is that the healthcare delivery system is a large, complex, and sophisticated value creation chain. Successfully changing this highly interconnected system is difficult and time consuming because the underlying problems are hard to comprehend, the root causes are many, the solution is unclear, and the relationships among problems, causes, and solution are multifaceted. To address these issues, the book carefully explains the underlying problems, examines their root causes using information, data, and logic, and presents a comprehensive and integrated solution that addresses these causes. These three steps are the methodological backbone of this book. A solution depends on understanding and applying the principles of patient-centered care (PCC) and resource management. PCC puts patients, supported by their primary care physicians, back in the role as decision makers and depends on patients being responsible for their health including making good life-style choices. After all, the best way to reduce healthcare costs and increase quality of life is to improve our health and wellness and as a result need less care. In addition, health insurance must be rethought and redesigned so it is less likely to lead to overuse. For many people with health insurance, the out-of-pocket cost of healthcare are small, so healthcare decision making is often biased toward consumption. Effective resource management means that healthcare providers must do a better job of acquiring and using resources in order to provide care quickly, productively, and correctly. This means improving healthcare strategy and management, accelerating the use of information technology, making drug costs affordable and fair, reducing the incidence of malpractice, and rebuilding the provider network. In addition, implementation is difficult because there are many participants in the healthcare delivery value chain, such as physicians, nurses, and medical technicians, as well as many provider organizations, such as hospitals, clinics, physician offices, and labs. Further up the value chain there are pharmaceutical companies, equipment providers, and other suppliers. These participants have diverse and sometimes conflicting goals, but each must be willing to accept change and work in a coordinated manner to improve healthcare. To overcome these problems, strong national leadership is needed to get the attention and support from the people and organizations involved in healthcare and to make the comprehensive changes that will lower healthcare costs, improve healthcare quality, eliminate delays, increase access, and enhance patient satisfaction.

Sponsored by the Picker/Commonwealth Program for Patient-Centered Care In this comprehensive, research-based look at the experiences and needs of patients, the authors explore models of care that can make hospitalization more humane. Through the Patient's Eyes provides insights into why some hospitals are more patient-centered than others; how physicians can become more involved in patient-centered quality efforts; and how patient-centered quality can be integrated into health care policy, standards, and regulations. The authors show how, by bringing the patient's perspective to the design and delivery of health services, providers can improve their ability to meet patient's needs and enhance the quality of care.

This User’s Guide is intended to support the design, implementation, analysis, interpretation, and quality evaluation of registries created to increase understanding of patient outcomes. For the purposes of this guide, a patient registry is an organized system that uses observational study methods to collect uniform data (clinical and other) to evaluate specified outcomes for a population defined by a particular disease, condition, or exposure, and that serves one or more predetermined scientific, clinical, or policy purposes. A registry database is a file (or files) derived from the registry. Although registries can serve many purposes, this guide focuses on registries created for one or more of the following purposes: to describe the natural history of disease, to determine clinical effectiveness or cost-effectiveness of health care products and services, to measure or monitor safety and harm, and/or to measure quality of care. Registries are classified according to how their populations are defined. For example, product registries include patients who have been exposed to biopharmaceutical products or medical devices. Health services registries consist of patients who have had a common procedure, clinical encounter, or hospitalization. Disease or condition registries are defined by patients having the same diagnosis, such as cystic fibrosis or heart failure. The User’s Guide was created by researchers affiliated with AHRQ’s Effective Health Care Program, particularly those who participated in AHRQ’s DEcIDE (Developing Evidence to Inform Decisions About Effectiveness) program. Chapters were subject to multiple internal and external independent reviews.

v. 1. Research findings -- v. 2. Concepts and methodology -- v. 3. Implementation issues -- v. 4. Programs, tools and products.