AAOS strengthens commitment to patient-centered care in new initiative

By Mary Ann Porucznik

“Patient-centered care is the provision of safe, effective and timely musculoskeletal care achieved through cooperation among the orthopaedic surgeon, an informed and respected patient (and family) and a coordinated health care team.”

Thus reads the AAOS definition of “Patient-Centered Care (PCC).” Now, the Academy is helping orthopaedists put that definition into practice with a focused initiative that enhances current tools and programs, and will develop new tools and products to help orthopaedists better understand and implement the principles of patient-centered care. The program also aims to help patients and the public learn about and participate in patient-centered care.

AAOS President Stuart L. Weinstein, MD, announced the initiative in his Presidential address during last year’s Annual Meeting. With a strong personal commitment to patient-centered care, Dr. Weinstein said, “This year I will be asking you to work with me, and with the Academy, to create a culture of patient-centered care—in our organization and in our individual practices.”

He called attention to a “newly-evolving health care paradigm, patient-centered care” and noted that patient-centered care puts the patient in control, involves a free-flow of information, evidenced-based decision making and cooperation among physicians.

In the intervening year, a number of strides have been made toward accomplishing Dr. Weinstein’s vision for patient-centered care.

The first step was creation of a Patient-Centered Care Project Team—comprised of Dr. Weinstein as chair; J. Sybil Biermann, MD; Dwight W. Burney III, MD; Frances A. Farley, MD; Mark C. Gebhardt, MD; Michael J. Goldberg, MD; Lowry Jones Jr., MD; Andrew N. Pollak, MD; John M. Purvis, MD; John R. Tongue, MD, and James N. Weinstein, DO, MS—in conjunction with AAOS staff members. The team developed a comprehensive business plan for facilitating and promoting patient-centered care, which was subsequently approved for implementation by the AAOS Board of Directors. The program theme is “Getting Better Together.”

“The PCC initiative approved by the Board is initially a three-year program, but patient-centered care must be an integral part of orthopaedic practice for the long term,” said Dr. Weinstein.

Practice implications

Although many physicians believe that they perform patient-centered medicine, their belief is often based on their commitment to listen to the patient. Simply listening well to the patient’s complaints and symptoms before making a diagnosis was a major shift in the modern practice of medicine. Others may argue that “doing the best thing for the patient” is delivering patient-centered care.

But today’s concept of “patient-centered care” represents a new paradigm in health care. Instead of the physician being the decision-maker, it is the patient who decides what is best, in conjunction with the physician. For physicians, this means “seeing things through the eyes of the patient.”

Today, many physicians try to see as many patients as possible in the shortest amount of time possible. Many, if not most, orthopaedists are convinced that almost all of their income is generated from the procedural side of their practices. With the increase in reimbursement for evaluation and management (E&M) services and the decrease in reimbursement for procedures, this is, in fact, not true. E&M services generate about 40 percent of an orthopaedist’s income. Therefore, from a financial perspective, E&M services are an extremely important part of orthopaedic practice.

More importantly, E&M services are a vital part of good patient care. Taking a few more minutes to listen and talk with each patient can avoid confusion for both parties, minimize the need to cover the same topics repeatedly and reduce the risk of medical liability suits when unrealistic patient expectations are not met, thus saving time as well as money. This is one of the hallmarks of patient-centered care.

Another hallmark is active participation by patients in their care. When patients are informed and involved, medical errors and litigation are reduced. Active patient participation also helps reduce unnecessary testing, improves compliance with treatment regimens, increases patient satisfaction and improves outcomes.

AAOS PCC initiatives

The PCC initiative has four goals:

The project team identified the scope of activities upon which it wished to focus its attention:

The activities that are being developed to accomplish these goals include producing member and patient education materials; expanding the reach of the AAOS patient education Web site (Your Orthopaedic Connection); expanding the Communications Skills Mentoring Program; developing cultural competency programs; creating patient safety programs and materials; developing evidence-based practice guidelines; and conducting advocacy efforts for access to care and funding for research. Following are highlights of what’s been accomplished thus far.

Patient/Public Education

A centerpiece of the Academy’s patient-centered care initiative is the AAOS patient education Web site, Your Orthopaedic Connection. The site now features a new section on patient-centered care, that includes information on how to improve patient/physician communication, enhance decision-making and support the implementation of patient-centered care.

During 2006, new patient-focused features, including the addition of an “Ask the Orthopaedist” option and a quarterly patient opinion survey, will expand the site’s interactivity.

The AAOS 2006 public service advertising campaign takes a decided focus on “Getting Better Together” through patient-centered care. The print and radio ads will help patients and the public understand the significance of collaborating with their physicians to jointly make the best health care decisions.

The print ad carries a main message of “Got questions for your doctor? Write them down.” It informs patients that open, honest communication, which includes asking doctors medical questions, is essential to understanding available treatment options. The radio ads (60- and 30-second), have the theme “Date with a Doc” and highlight the importance of patients’ bringing a friend or family member to doctor appointments to make sure the patient and physician understand each other. You can read more about the Academy’s 2006 PSA campaign in tomorrow’s Academy News.

Tools for Members

To help members implement PCC projects in their communities, the Public Education and Media Relations (PEMR) Department is producing an array of free educational tools. These materials include a Patient-Centered Care Tool kit, a patient-centered care video that orthopaedic surgeons can play in their reception rooms; and a PowerPoint presentation for Academy members to use in their communities.

PEMR also conducted a radio media tour, featuring Dr. Weinstein, who discussed the topic of patient-centered care with radio stations across the country earlier this month.

Additional support will come from an expanded Communication Skills Mentoring Program (CSMP). Already CSMP mentors have provided training to nearly 1,000 AAOS members and seven residency programs. The AAOS plans to reach orthopaedic residents in more than 140 residency programs by the end of 2008. The program will also be expanded to include new topics, such as how to manage difficult patients, how to access evidence-based practice information, patient decision aids and how to improve health literacy and cultural competence.

In the future, the AAOS will also be working on developing patient and member satisfaction surveys, as well as a program to teach office and operating suite employees the principles of PCC.

One key element of the program will be a signal to the public that AAOS members support patient-centered care. This includes asking AAOS members to sign a patient-centered care pledge, similar to the voluntary pledge many have already signed regarding the provision of appropriate expert witness testimony.

AAOS is asking members to go on the Academy’s Web site and record their participation by pledging to provide Patient-Centered Care as a routine part of their practice. A list of members who have pledged to provide patient-centered care will be available on the AAOS Web site. To learn more about how to participate in this effort, see the accompanying article on the affirmation statement.

Partnering

In 2005, the Academy joined the National Health Council (NHC), a coalition of patient-focused organizations. AAOS is one of just a few medical societies that are part of the NHC. Dr. Weinstein represents AAOS on the group’s Board of Directors.

Through its involvement in the NHC and its broad scope of patient-centered care activities, the AAOS has already become a national leader in this effort. However, it will be the individual orthopaedic surgeon who not only implements patient-centered care but will benefit from it as well.

“As a champion for the patient’s interests, the orthopaedist who provides patient-centered care will ensure that the patient (and the patient’s family) is informed, respected and involved in care decisions and treatment,” said Dr. Weinstein. “As a leader in the health care community, the orthopaedist will cooperate with all members of the patient’s health care team to coordinate and deliver care and treatment in a way that respects the patient’s beliefs and needs.

“As the AAOS and our members begin to implement the PCC initiative—in our organization and in our practices, I am confident that the results will be beneficial, particularly for the fellowship,” he concluded.

Order a Patient-Centered Care kit!

To help orthopaedists spread the word about patient-centered care (PCC) to their patients and communities, the Academy has created a free Patient-Centered Care kit for its members. (Members pay shipping/handling charges only.)

Each kit includes:

    PCC-related public service announcement postcards

    A DVD containing the PCC film

    A PCC affirmation statement form and instructions

    A Community Orthopaedics Awareness Program (COAP) CD that contains a PCC PowerPoint presentation and script

    A “tool kit” explaining how to use all of the materials

    An order form to request a frameable certificate of the PCC affirmation statement in your choice of sizes (8” x 11” or 14” x 17”), or to re-order any of the above materials

You can pick up your own PCC kit at the Public Education and Media Relations kiosk, located in the AAOS Resource Center in Hall B. Or,order a PCC kit after you return to your office by calling the Public Education and Media Relations department at (847) 384-4036, or e-mail pemr@aaos.org.

PCC affirmation sign-up forms can also be found in the Patient Education/Internet Communications booth across from the Resource Center; you will also be able to file your affirmation form electronically at the booth. AAOS staff will be on hand to assist you in both the PEMR and Patient Education and Media Relations display areas.


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