Meeting the Challenge of a More Person-centered Future for US Healthcare

Person-centered care is a burgeoning social movement and a mission statement for modern healthcare. However, it is not a new idea. Often called the father of modern medicine, William Osler said, “The good physician treats the disease; the great physician treats the patient who has the disease.” Social movements typically begin with common issues brought forward by an affected group whose members share a common interest in a cause. Health-based social movements (HSMs) such as the women\u27s health movement and breast cancer activism have significantly impacted health and social policy. The movement toward person-centeredness grew from a number of narrow interest-based activists to a more general movement for healthcare reform from objections to both medicalization and medical paternalism, and the demands for increased autonomy and choice which arose from the cultural and political shifts of the 1960s. In addition, the increasing prevalence of long-term chronic conditions has led to the necessity of new models to manage disease and disability that empower people living with the health condition to gain greater control of their health and healthcare decisions

Learning Evaluation: Blending Quality Improvement and Implementation Research Methods to Study Healthcare Innovations

Background: In healthcare change interventions, on-the-ground learning about the implementation process is often lost because of a primary focus on outcome improvements. This paper describes the Learning Evaluation, a methodological approach that blends quality improvement and implementation research methods to study healthcare innovations. Methods: Learning Evaluation is an approach to multi-organization assessment. Qualitative and quantitative data are collected to conduct real-time assessment of implementation processes while also assessing changes in context, facilitating quality improvement using run charts and audit and feedback, and generating transportable lessons. Five principles are the foundation of this approach: (1) gather data to describe changes made by healthcare organizations and how changes are implemented; (2) collect process and outcome data relevant to healthcare organizations and to the research team; (3) assess multi-level contextual factors that affect implementation, process, outcome, and transportability; (4) assist healthcare organizations in using data for continuous quality improvement; and (5) operationalize common measurement strategies to generate transportable results. Results: Learning Evaluation principles are applied across organizations by the following: (1) establishing a detailed understanding of the baseline implementation plan; (2) identifying target populations and tracking relevant process measures; (3) collecting and analyzing real-time quantitative and qualitative data on important contextual factors; (4) synthesizing data and emerging findings and sharing with stakeholders on an ongoing basis; and (5) harmonizing and fostering learning from process and outcome data. Application to a multi-site program focused on primary care and behavioral health integration shows the feasibility and utility of Learning Evaluation for generating real-time insights into evolving implementation processes. Conclusions: Learning Evaluation generates systematic and rigorous cross-organizational findings about implementing healthcare innovations while also enhancing organizational capacity and accelerating translation of findings by facilitating continuous learning within individual sites. Researchers evaluating change initiatives and healthcare organizations implementing improvement initiatives may benefit from a Learning Evaluation approach