Health technology and patient-centered principles shown to improve care
■ A review of studies suggests the two strategies may be mutually dependent.
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Using both patient-centered care principles and health information technology improves care, according to the bulk of evidence published during the last 14 years.
Researchers at the Johns Hopkins University Evidence-Based Practice Center reviewed 327 published articles examining results of health IT tools used in implementing patient-centered care. The studies looked at health outcomes for patients with a range of health conditions, including diabetes, heart disease, depression and cancer. The review was limited to research published in 1998 or later.
“Substantial evidence exists confirming that health IT applications with patient-centered care-related components have a positive effect on health care outcomes,” researchers wrote in a report published June 14 by the Agency for Healthcare Research and Quality.
The reviewers were working under a definition of patient-centered care determined by the Institute of Medicine: “care that is respectful of and responsive to individual patient preferences, needs and values and ensuring that patient values guide all clinical decisions.” They looked for research involving specific elements of patient-centered care, including coordination and integration of care, whole-person orientation, enhanced clinician-patient relationship, clinical information systems and socio-cultural competence.
The reviewers included a long list of health IT tools in their search, including clinical decision aids, shared decision-making tools, and telemedicine or telemonitoring systems, Teresa Zayas-Cabán, PhD, senior manager for health IT at the AHRQ, wrote in an emailed comment.
To gauge the degree to which health IT and patient-centered care used together improved care, the reviewers examined whether researchers studying the use of health IT in conjunction with patient-centered care recorded improvements in the health of patients, or reported “health care process outcomes” — cases in which a physician or other clinician followed standards of care.
They found that in most cases, either clinical or process outcomes were better when health IT was involved in patient-centered care.
The findings may give weight to the idea that spending money and time on technology to enable patient-centered care is a worthwhile investment.
Technology by itself doesn’t improve care, but patient-centered care does require health IT, said MaryAnne Sterling, a Washington-based health IT consultant.
But by the same token, health IT has to be part of a larger care strategy, she said. “It’s not just about plugging in the technology. Plugging it in is the first of many steps.”
The study also identified barriers to success where patient-centered care and technology come together. Those included limited patient access to technology due to their older age, lower income or education level, as well as low computer literacy of both patients and clinicians.