How can you make patient-centered decisions in case management?

The assessment phase should be cyclical. 1. Initial Assessment: - Gather comprehensive medical and personal information - Understand patient's needs, motivations, and support system 2. Regular Re-Assessment: - Recognize changing emotional states and priorities - Update your understanding of the patient 3. Holistic Understanding: - Look beyond objective medical data - Prioritize patient's input about experiences and values - Grasp what truly matters to them 4. Active Patient Involvement: - Communicate openly before decisions - Ensure patients participate in care planning Patient-centered care means knowing the person behind the patient. Prioritize understanding their unique needs and values, not just symptoms.

In my time as a healthcare strategist, particularly focused on Non-Communicable Diseases (NCD), understanding the nuances of individual patients was paramount. Each patient comes with a unique set of life circumstances, beliefs, and priorities. In one instance, while working on a community engagement project, I encountered a patient who was resistant to standard NCD interventions due to cultural beliefs. By investing time in understanding her perspective and values, we tailored an approach that honored her beliefs while still effectively managing her condition.

One of my favourite parts of therapy is meeting clients for the first time, at the initial apt. My number one job is to create a space they can trust, a space that is consistent. I’m meeting them where they are at, being with them in the moment. Only after our session is over do I start assessing different aspects of our session. Sometimes when we meet people for the first time , we don’t show up authentically. This isn’t because we are dishonest or trying to convince people otherwise, but we are assessing the situation and making judgements about how the relationship will move forward. Patients and clients need to know that we are speaking their language and feel our willingness to learn.

Patient centered decision making in CM is often times tough to do if you are within a rural area where the environmental factors outweigh the work and progress that has been down and shown by the patient.For one, constant communication with your patient should always be at the forefront of the decision. Is the patient mobile? Do they have RELIABLE transportation? Do they have a history of missed appointments? All of these are factors in which your decision will be impactful to your decisions for your patient. Ask your patient, what are decisions you are allowed to assist in making on their behalf or with their help. True patient centered decisions involve the patient in which you work WITH.

When I walk into a patient's room to begin an assessment, I always stop for a moment and ask sincerely, "How are you? How are you feeling?" I'm not looking for the simple social answer of "fine." I make eye contact and take the time to listen to the patient's answer. I ask follow up questions. I include the people in the room. "Who is with you you today?" "How long have you been together?" When I show genuine interest in my patient's life, they are more likely to trust me. They are more likely to trust me with their wishes and goals for their health care. Then we can move forward collaboratively with care planning.

During the development of national NCD strategic plans, one size never fit all. Similarly, in case management, interventions need to be individually tailored. For example, in one of our corporate wellness programs, we identified that while the general blueprint worked for a majority, there were always outliers. For one particular patient, a standard fitness regimen was not motivating enough. By understanding his love for dance, we incorporated dance-based fitness routines, leading to a significant increase in his participation and subsequent health improvements.

While evidence-based medicine and standards of practice provide a framework, it's the understanding of the patient's unique context that ensures successful outcomes. Interprofessional collaboration with doctors, nurses, social workers, and community agencies is essential. They provide diverse insights and resources that enrich the care plan. However, it's vital to remember that every intervention, no matter how clinically sound, must be aligned with the patient's values and goals. A truly effective care plan isn't just about medical outcomes; it's about honoring and facilitating a patient's journey towards their desired quality of life.

I recall a project where we had to integrate NCD prevention into primary healthcare. While the plans were robust on paper, practical implementation was met with unforeseen challenges. One patient was hesitant to adopt a new dietary plan due to financial constraints. Recognizing this, we collaborated with community organizations to provide subsidized healthy food options. It taught me that true patient-centered care means looking beyond medical recommendations to ensure holistic support.

Implementing patient-centered decisions in case management demands a dynamic and proactive approach. As actions unfold according to the care plan, continuous monitoring is essential. Empowering the patient through information, education, and support ensures they remain an active participant in their journey. Documentation is crucial, capturing the nuances of interventions and allowing for iterative refinement. The effectiveness of any intervention isn't a mere clinical outcome; it's gauged by patient feedback and their evolving needs. True patient-centered care embraces flexibility, adapting to each patient's unique journey and feedback, ensuring that care remains personalized, relevant, and in tune with their holistic well-being.

Post-implementation of any strategy, especially in health care system strengthening, a rigorous review is non-negotiable. In one memorable instance, after integrating a new NCD-focused health policy in a regional healthcare system, initial feedback was positive. However, a deeper dive revealed that while healthcare professionals were equipped with new knowledge, they felt overwhelmed. This led us to introduce additional training sessions, emphasizing real-world scenarios and peer discussions. Continuous feedback loops are not just about numbers; they're about the lived experiences of those we serve.

The one thing I have learned as a Vocational Rehabilitation Counselor is to LISTEN and OBSERVE a client. If you ask a client what their dream job is, don't dismiss it just because of a disability they may have. When listening to a client, we use situational assessments to determine a clients strengths, weaknesses, abilities and stamina to complete a job. Every detail documented matters.

Reviewing and reflecting in case management encapsulates the essence of continuous improvement. By gauging the tangible impact of interventions on a patient's holistic well-being and deriving insights from all stakeholders, we can foster a feedback-rich environment. This process is not just about celebrating successes but also about understanding shortcomings. Unpacking the multitude of factors, both aiding and impeding, refines our decision-making prowess. The power of this reflective phase lies not in its backward glance but its forward vision: using today's lessons to sculpt a more informed, empathetic, and effective approach for tomorrow's patients. The cycle of patient-centered care, thus, continues, ever-evolving and ever-improving.

Patient-centered decisions have ripple effects. They don’t just impact the immediate health of an individual but also their overall quality of life. I remember spearheading a behavioral change intervention where, beyond just medical outcomes, we measured parameters like patient happiness, family relationships, and workplace productivity. To truly honor the principle of patient-centeredness, it’s essential to consider the broader picture of what health means to each individual. Whether it's providing additional resources like support groups or advocating for broader policy changes, always be prepared to go the extra mile.

While it's crucial to engage patients families or caregivers in the assessment phase, but it is equally essential to obtain the patient's consent. This consent requirement should extend to the involvement of other care providers and stakeholders. The primary reason behind this is the potential presence of confidential patient data, which should only be accessed on a need-to-know basis. In such cases, implementing role-based access controls (RBAC) is highly recommended, coupled with a rigorous audit trail to monitor access and usage. Moreover, any insights gained from case management should be diligently documented under 'lessons learned’ and shared with the relevant care provider team to facilitate continuous improvement in future practices

"Patient-centered care is a method of care that relies upon effective communication, empathy, and a feeling of partnership between doctor and patient," (Rickert, 2012). Care managers who want to affect change must leave their preconceived solutions at the door to the patient's room. We bring our objective knowledge and resources in with us, along with our empathy and compassion. Then we can move forward to an improved outcome with the patient as the central member of the team. Reference "Patient-Centered Care: What It Means And How To Get There", Health Affairs Blog, January 24, 2012. DOI: 10.1377/hblog20120124.016506

Achieving patient-centered decisions in case management involves recognizing patients as crucial stakeholders and actively involving them in decision-making. By engaging patients, case managers gain valuable insights into their unique needs and challenges, fostering collaboration in identifying gaps, co-creating solutions, and developing personalized care plans. This approach empowers patients, promotes transparency, and establishes trust, ultimately enhancing the relevance and effectiveness of the case management process. Regular communication and shared decision-making contribute to a more patient-centric and responsive healthcare approach

In the realm of patient-centered decisions, one cannot underestimate the power of the intangibles: the fleeting smile of gratitude, the relief in a patient's eyes, the anecdote shared by a caregiver. While structured processes guide us, it's these unscripted moments that truly illuminate the heart of case management. Remember the elderly man who, despite his pain, only wished to dance at his granddaughter's wedding. Or the young mother whose only query was if she'd be home for her son's first birthday. These stories serve as poignant reminders that at the core of our rigorous methodologies are real humans with hopes, fears, dreams, and desires. Let these narratives anchor us, reminding us of the humanistic essence of our profession.