DNP 835 Topic 7 Discussion Question One
DNP 835 Topic 7 Discussion Question One
Utilize the National Committee for Quality Assurance (NCQA) website to examine the criteria that a Patient Centered Medical Home (PCMH) must meet to be credentialed. What is the value of the PCMH to patient outcomes?
Value is defined as “the material or monetary worth of something.”20 In business language, customers define value by quantifying what they would pay for a service or product. In the language of health care, patients or persons define value by expressing what they want from care and what they or their payers will pay for it.
Notwithstanding a decade of espousing patient-centered care, research defining patient value is limited and is generally based on authors’ personal opinions or where empirical, on operational service elements.
In our experience, which is derived from several decades of work supporting health care quality improvement, 5 concepts can be used to describe what patients value: health, cure, healing, preconditions of health, and experience of care.
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Health is understood as a high level of experience and functioning across physical/somatic, cognitive/emotional, social/productive, and spiritual dimensions, and the capacity for maintaining them.
- Cure is the restoration of a high level of experience and functioning in 1 or more of the dimensions of health, most often the
DNP 835 Topic 7 Discussion Question One
physical/somatic.
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Healing is improvement in the cognitive/emotional and spiritual dimensions, integrated with improvement in physical/somatic and social/productive dimensions. Healing is experienced through transcendence of the suffering that comes with illness, integration of its meaning with our life story, and achievement of functional potential.24–26
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Preconditions of health include support for housing, food, jobs and income, and activities of daily living.
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Finally, experience of care is based on perceived access, relationship, technical excellence, and amenities.
People differ in the emphasis that they place on these 5 components of value. Generally, healthy people value optimization and maintenance of health. Cure is highly valued where it is possible, particularly in acute situations. Healing is valued in chronic illness, alongside support for the preconditions of health in disadvantaged or disabled populations. Most of us value the experience of care.
We propose a patient-centered value framework based on these concepts, in which value is quantified by what patients are willing to pay for the components (directly or through insurance), as shown in Figure 1. It is consistent with, but more patient centered than, the most widely accepted current vision—the so-called triple aim of improving quality and population health while reducing cost.