AAOS Bulletin - June, 2006

AAOS strengthens commitment to patient-centered care

By Frances A. Farley, MD

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.

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 important, 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, which requires that physicians practice culturally competent 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:

1. To improve the quality of health care provided to patients with musculoskeletal conditions treated by members of the AAOS

2. To increase patient satisfaction with orthopaedic care

3. To increase AAOS member satisfaction with their practice, improve outcomes, decrease liability risks and improve practice efficiency

4. To place the AAOS in the leadership position among physician groups in the patient-centered care movement

The AAOS Patient-Centered Care Project Team is undertaking several activities to help achieve these goals. Member education efforts will help explain patient-centered care and its importance. Patient education efforts will educate patients about patient-centered care and why orthopaedic surgeons are both committed to it and taking a leadership role in this movement. Both members and patients will be provided with the tools they need to implement patient-centered care. Finally, the AAOS is developing partnerships with other organizations to create projects and activities that will position the AAOS as a lead organization in patient-centered care.

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.

For example, to improve your cultural competence, you can take the Cultural Competency Challenge. This free CD was developed to help you gauge your cultural care IQ, using patient cases and multiple-choice questions. It’s one step in your commitment to providing quality care to every patient you see. You can download the program at the AAOS Diversity Web site.

Affirmation Statement

A key element of the program will be a signal to the public that AAOS members support patient-centered care. The AAOS has developed a patient-centered care pledge—similar to the voluntary pledge regarding the provision of appropriate expert witness testimony—for members.

You can show your support for the PCC initiative by signing the affirmation statement and displaying the pledge certificate. AAOS members who sign the PCC affirmation statement will receive a tabletop or wall-size certificate (or both) suitable for framing that can be displayed in your office, examination rooms or reception room.

You can access the affirmation statement by logging onto the AAOS Web site from your home or office computer. After agreeing to the PCC tenets, you will be asked whether you want the small certificate, the large one or both. Make your selection and it will be mailed to you. Or call Sylvia Delk in the AAOS medical affairs department at (847) 384-4043 and request a certificate. You should then sign it and display it in your office, reception room or examination room.

Partnering

In 2005, the Academy joined the National Health Council (NHC), a coalition of patient-focused organizations. The AAOS is one of just a few medical societies that are part of the NHC. Stuart L. Weinstein, MD, represents the Academy 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 who 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.”

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. 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 (8-1/2” x 11” or 14” x 17”), or to re-order any of the above materials

To order your free PCC kit (Members pay shipping/handling charges only), call the public education and media relations department at (847) 384-4036, or e-mail pemr@aaos.org.

Frances A. Farley, MD, chairs the AAOS Patient-Centered Care Project Team. She can be reached at fafarley@umich.edu


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