This book challenges functional models for more aesthetic and ethical models, where communication is grounded in values systems of cultures. Here, communication is treated as a distributed phenomenon involving networks of persons, activities and artifacts, and extends beyond doctor-patient relationships to working in and across teams around patients. The purpose of the book is to stimulate thinking about how patient care and safety may be improved through a focus upon the ‘non-technical’ work of doctors – interpersonal communication, teamwork and situation awareness in teams. The focus is then not on the personality of the doctor, but on the dynamics of relationships which form doctors’ multiple identities.
Advances in trauma care have accelerated over the past decade, spurred by the significant burden of injury from the wars in Afghanistan and Iraq. Between 2005 and 2013, the case fatality rate for United States service members injured in Afghanistan decreased by nearly 50 percent, despite an increase in the severity of injury among U.S. troops during the same period of time. But as the war in Afghanistan ends, knowledge and advances in trauma care developed by the Department of Defense (DoD) over the past decade from experiences in Afghanistan and Iraq may be lost. This would have implications for the quality of trauma care both within the DoD and in the civilian setting, where adoption of military advances in trauma care has become increasingly common and necessary to improve the response to multiple civilian casualty events. Intentional steps to codify and harvest the lessons learned within the military's trauma system are needed to ensure a ready military medical force for future combat and to prevent death from survivable injuries in both military and civilian systems. This will require partnership across military and civilian sectors and a sustained commitment from trauma system leaders at all levels to assure that the necessary knowledge and tools are not lost. A National Trauma Care System defines the components of a learning health system necessary to enable continued improvement in trauma care in both the civilian and the military sectors. This report provides recommendations to ensure that lessons learned over the past decade from the military's experiences in Afghanistan and Iraq are sustained and built upon for future combat operations and translated into the U.S. civilian system.
Patient-centered care is a way of thinking and doing things that considers patients partners in the development of a healthcare plan designed to meet their specific needs. It involves knowledge of the individual as a person and integrates that knowledge into their plan of care. Patient-centered care is central to the discussion of healthcare at the insurance and hospital-level. The quality of the service is evaluated more deeply from all the healthcare components, including insurance payments. It is the start of a new client- and patient-centered healthcare, which is based on a profound respect for patients and the obligation to care for them in partnership with them. Healthcare has been lacking a strategy to teach patients how to take care of themselves as much as they possibly can. In countries with socialized healthcare, patients don’t go to the emergency room unless it is necessary; they have a physician on call instead. This affords more personalized care and avoids patients getting lost in the hospital system. This book advocates the critical role of patients in the health system and the need to encourage healthy living. We need to educate patients on how to be more self-aware, giving them the tools to better understand what they need to do to achieve healthy lifestyles, and the protocols and policies to sustain a better life. Prevention has always been the pinnacle of medical care. It’s time to highlight and share this approach with patients and involve them as active participants in their own healthcare. This is the method on which to build the new healthcare for the next century.
In the United States, approximately 14 million people have had cancer and more than 1.6 million new cases are diagnosed each year. However, more than a decade after the Institute of Medicine (IOM) first studied the quality of cancer care, the barriers to achieving excellent care for all cancer patients remain daunting. Care often is not patient-centered, many patients do not receive palliative care to manage their symptoms and side effects from treatment, and decisions about care often are not based on the latest scientific evidence. The cost of cancer care also is rising faster than many sectors of medicine--having increased to $125 billion in 2010 from $72 billion in 2004--and is projected to reach $173 billion by 2020. Rising costs are making cancer care less affordable for patients and their families and are creating disparities in patients' access to high-quality cancer care. There also are growing shortages of health professionals skilled in providing cancer care, and the number of adults age 65 and older--the group most susceptible to cancer--is expected to double by 2030, contributing to a 45 percent increase in the number of people developing cancer. The current care delivery system is poorly prepared to address the care needs of this population, which are complex due to altered physiology, functional and cognitive impairment, multiple coexisting diseases, increased side effects from treatment, and greater need for social support. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis presents a conceptual framework for improving the quality of cancer care. This study proposes improvements to six interconnected components of care: (1) engaged patients; (2) an adequately staffed, trained, and coordinated workforce; (3) evidence-based care; (4) learning health care information technology (IT); (5) translation of evidence into clinical practice, quality measurement and performance improvement; and (6) accessible and affordable care. This report recommends changes across the board in these areas to improve the quality of care. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis provides information for cancer care teams, patients and their families, researchers, quality metrics developers, and payers, as well as HHS, other federal agencies, and industry to reevaluate their current roles and responsibilities in cancer care and work together to develop a higher quality care delivery system. By working toward this shared goal, the cancer care community can improve the quality of life and outcomes for people facing a cancer diagnosis.
The idea of person-centred health systems is widely advocated in political and policy declarations to better address health system challenges. A person-centred approach is advocated on political, ethical and instrumental grounds and believed to benefit service users, health professionals and the health system more broadly. However, there is continuing debate about the strategies that are available and effective to promote and implement 'person-centred' approaches. This book brings together the world's leading experts in the field to present the evidence base and analyse current challenges and issues. It examines 'person-centredness' from the different roles people take in health systems, as individual service users, care managers, taxpayers or active citizens. The evidence presented will not only provide invaluable policy advice to practitioners and policymakers working on the design and implementation of person-centred health systems but will also be an excellent resource for academics and graduate students researching health systems in Europe. This title is available as Open Access on Cambridge Core.
In the exciting and growing field of hospital medicine, you're as concerned with the efficient management of your unit as you are the effective care of your patients. This title is your ideal new clinical reference on both counts. Nationally recognized experts equip you with practical, actionable guidance on all of the challenges you face every day—making it easier for you to provide optimal care for every patient. State-of-the-art, evidence-based, hospital-focused guidelines on clinical assessment, diagnosis, prognosis, treatment, and discharge/follow-up planning help you to effectively manage all of the key disorders in every body system. 20 chapters focused on peri-operative care assist you in navigating this increasingly important component of hospital medicine practice. Expert advice on systems issues explores how to establish and enhance a hospitalist program, provide leadership, manage patient transitions of care, establish a teamwork model with hospital staff, promote patient safety and staff performance improvement, standardize care, and navigate legal and ethical concerns.
This long awaited Third Edition fully illuminates the patient-centered model of medicine, continuing to provide the foundation for the Patient-Centered Care series. It redefines the principles underpinning the patient-centered method using four major components - clarifying its evolution and consequent development - to bring the reader fully up-to-
For patients and their loved ones, no care decisions are more profound than those made near the end of life. Unfortunately, the experience of dying in the United States is often characterized by fragmented care, inadequate treatment of distressing symptoms, frequent transitions among care settings, and enormous care responsibilities for families. According to this report, the current health care system of rendering more intensive services than are necessary and desired by patients, and the lack of coordination among programs increases risks to patients and creates avoidable burdens on them and their families. Dying in America is a study of the current state of health care for persons of all ages who are nearing the end of life. Death is not a strictly medical event. Ideally, health care for those nearing the end of life harmonizes with social, psychological, and spiritual support. All people with advanced illnesses who may be approaching the end of life are entitled to access to high-quality, compassionate, evidence-based care, consistent with their wishes. Dying in America evaluates strategies to integrate care into a person- and family-centered, team-based framework, and makes recommendations to create a system that coordinates care and supports and respects the choices of patients and their families. The findings and recommendations of this report will address the needs of patients and their families and assist policy makers, clinicians and their educational and credentialing bodies, leaders of health care delivery and financing organizations, researchers, public and private funders, religious and community leaders, advocates of better care, journalists, and the public to provide the best care possible for people nearing the end of life.
The U.S. population of older adults is predicted to grow rapidly as "baby boomers" (those born between 1946 and 1964) begin to reach 65 years of age. Simultaneously, advancements in medical care and improved awareness of healthy lifestyles have led to longer life expectancies. The Census Bureau projects that the population of Americans 65 years of age and older will rise from approximately 40 million in 2010 to 55 million in 2020, a 36 percent increase. Furthermore, older adults are choosing to live independently in the community setting rather than residing in an institutional environment. Furthermore, the types of services needed by this population are shifting due to changes in their health issues. Older adults have historically been viewed as underweight and frail; however, over the past decade there has been an increase in the number of obese older persons. Obesity in older adults is not only associated with medical comorbidities such as diabetes; it is also a major risk factor for functional decline and homebound status. The baby boomers have a greater prevalence of obesity than any of their historic counterparts, and projections forecast an aging population with even greater chronic disease burden and disability. In light of the increasing numbers of older adults choosing to live independently rather than in nursing homes, and the important role nutrition can play in healthy aging, the Institute of Medicine (IOM) convened a public workshop to illuminate issues related to community-based delivery of nutrition services for older adults and to identify nutrition interventions and model programs. Nutrition and Healthy Aging in the Community summarizes the presentations and discussions prepared from the workshop transcript and slides. This report examines nutrition-related issues of concern experienced by older adults in the community including nutrition screening, food insecurity, sarcopenic obesity, dietary patterns for older adults, and economic issues. This report explores transitional care as individuals move from acute, subacute, or chronic care settings to the community, and provides models of transitional care in the community. This report also provides examples of successful intervention models in the community setting, and covers the discussion of research gaps in knowledge about nutrition interventions and services for older adults in the community.
