Time for a thorough evaluation of patient-centered care.

P atient-centered care is now the goal for virtually all health-care systems, but what is it, and how is it measured? The Institute of Medicine (IOM) considers care to be patient centered if it, is " respectful of and responsive to individual patient preferences, needs, and values and ensures that patient values guide all clinical decisions. " 1 The IOM further separates patient-centered care into 8 dimensions, including respect for patient preferences, information, medication communication , coordination of care, emotional support, physical comfort , involvement of the family, continuity and transition, and access to care. The dominant metric used to measure patient-centered care is patient satisfaction, which is the measure that is most likely to be improved in trials of interventions aimed at 1 of these 8 dimensions. 2 Given the past indifference to patient satisfaction, the paradigm shift toward the patient's view is a welcome change. Hospitals and health care systems increasingly reward providers who obtain the highest rates of patient satisfaction. For many hospitals and clinics, it is their only measure of quality with a financial incentive. However, patient-centered care is only one aspect of quality of care as defined by the IOM. 1 Other aspects include safety, effectiveness, efficiency, and equity. In the drive toward 100% patient satisfaction, it is possible that these other aspects of quality may suffer. Is the race to the top of patient satisfaction in the best interest of the health and well-being of the population? Without a thorough evaluation of patient-centered interventions, we cannot optimize the use of our limited resources to provide the best care for everyone. One common interpretation of patient-centered care is delivering the care patients want, when they want it, and where they want it. It can be argued that the epitome of such care was delivered to Michael Jackson. 3 His personal physician (Dr Conrad Murray, a cardiologist) provided his requested treatment (highly effective sedation with propofol), when he wanted (to sleep), and where he wanted (at home without annoying monitoring equipment). Although the outcome (death from oversedation) was not what Michael wanted, Dr Murray's process of care was clearly aimed to improve Michael's satisfaction with care, although it led to a conviction of involuntary manslaughter. In all likelihood, Dr Murray received top scores on his Press-Ganey surveys, and he would have been recommended to others had his patient survived. Fortunately, few can afford such patient-centered care. …