Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jun 20;18(1):479.
doi: 10.1186/s12913-018-3246-z.

A person-centered integrated care quality framework, based on a qualitative study of patients' evaluation of care in light of chronic care ideals

Gro Berntsen  1   2 , Audhild Høyem  3 , Idar Lettrem  4 , Cornelia Ruland  3 , Markus Rumpsfeld  5   6 , Deede Gammon  7   8
Affiliations

A person-centered integrated care quality framework, based on a qualitative study of patients' evaluation of care in light of chronic care ideals

Gro Berntsen et al. BMC Health Serv Res. .

Abstract

Background: Person-Centered Integrated Care (PC-IC) is believed to improve outcomes and experience for persons with multiple long-term and complex conditions. No broad consensus exists regarding how to capture the patient-experienced quality of PC-IC. Most PC-IC evaluation tools focus on care events or care in general. Building on others' and our previous work, we outlined a 4-stage goal-oriented PC-IC process ideal: 1) Personalized goal setting 2) Care planning aligned with goals 3) Care delivery according to plan, and 4) Evaluation of goal attainment. We aimed to explore, apply, refine and operationalize this quality of care framework.

Methods: This paper is a qualitative evaluative review of the individual Patient Pathways (iPP) experiences of 19 strategically chosen persons with multimorbidity in light of ideals for chronic care. The iPP includes all care events, addressing the persons collected health issues, organized by time. We constructed iPPs based on the electronic health record (from general practice, nursing services, and hospital) with patient follow-up interviews. The application of the framework and its refinement were parallel processes. Both were based on analysis of salient themes in the empirical material in light of the PC-IC process ideal and progressively more informed applications of themes and questions.

Results: The informants consistently reviewed care quality by how care supported/ threatened their long-term goals. Personal goals were either implicit or identified by "What matters to you?" Informants expected care to address their long-term goals and placed responsibility for care quality and delivery at the system level. The PC-IC process framework exposed system failure in identifying long-term goals, provision of shared long-term multimorbidity care plans, monitoring of care delivery and goal evaluation. The PC-IC framework includes descriptions of ideal care, key questions and literature references for each stage of the PC-IC process. This first version of a PC-IC process framework needs further validation in other settings.

Conclusion: Gaps in care that are invisible with event-based quality of care frameworks become apparent when evaluated by a long-term goal-driven PC-IC process framework. The framework appears meaningful to persons with multimorbidity.

Keywords: Care process; Continuity of care; Delivery of healthcare; Evaluation research; Goal attainment; Health service research; Integrated care; Long-term conditions; Multimorbidity; Person-centered care.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

Both the Connect (application # 2010/3396/REK sør-øst B) and TO-study (application # 2011/1913) were submitted to the Regional Ethics Committee (REC) for assessment. REC approved the former, while REC waived the need for approval for the TO-study. The Regional Data Protection Officer approved both studies. Informants were contacted by their regular health provider, such as the cancer nurse, their primary care nursing contact, their GP, or by a representative of their local patient organization on behalf of the study. Eligible patients were informed about the aim of the study and provided with written information and the informed consent form. The participant contact information was forwarded to the research team only when the informed consent form had been signed. For the under-age child, the child’s parents consented to participate in the study on the child’s behalf.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
An overview of the stages of the research process included in this paper
See this image and copyright information in PMC

References

    1. Schoen C, Osborn R, Doty MM, Bishop M, Peugh J, Murukutla N. Toward higher-performance health systems: adults’ health care experiences in seven countries, 2007. Health Aff. 2007;26(6):w717–w734. doi: 10.1377/hlthaff.26.6.w717. - DOI - PubMed
    1. Hewitson P, Skew A, Graham C, Jenkinson C, Coulter A. People with limiting long-term conditions report poorer experiences and more problems with hospital care. BMC Health Serv Res. 2014. 10.1186/1472-6963-14-33. - PMC - PubMed
    1. Burgers JS, Voerman GE, Grol R, Faber MJ, Schneider EC. Quality and coordination of Care for Patients with Multiple Conditions: results from an international survey of patient experience. Eval Health Profes. 2010. 10.1177/0163278710375695. - PubMed
    1. Campbell SM, Gately C, Gask L. Identifying the patient perspective of the quality of mental healthcare for common chronic problems: a qualitative study. Chronic Illn. 2007;3(1):46–65. doi: 10.1177/1742395307079193. - DOI - PubMed
    1. Greenfield G, Ignatowicz AM, Belsi A, Pappas Y, Car J, Majeed A, Harris M. Wake up, wake up! It's me! It's my life! Patient narratives on person-centeredness in the integrated care context: a qualitative study. BMC Health Serv Res. 2014. 10.1186/s12913-014-0619-9. - PMC - PubMed

Publication types