Skip to main content

Advertisement

Log in

What is Patient-Centered Care? A Typology of Models and Missions

  • Original Article
  • Published:
Health Care Analysis Aims and scope Submit manuscript

Abstract

Recently adopted health care practices and policies describe themselves as “patient-centered care.” The meaning of the term, however, remains contested and obscure. This paper offers a typology of “patient-centered care” models that aims to contribute to greater clarity about, continuing discussion of, and further advances in patient-centered care. The paper imposes an original analytic framework on extensive material covering mostly US health care and health policy topics over several decades. It finds that four models of patient-centered care emphasize: patients versus their parts; patients versus providers; patients/providers/states versus “the system”; and patients and providers as persons. Each type is distinguishable along three dimensions: epistemological orientations, practical accommodations, and policy tools. Based on this analysis, the paper recommends that four questions be asked of any proposal that claims to provide patient-centered care: Is this care a means to an end or an end in itself? Are patients here subjects or objects? Are patients here individuals or aggregates? How do we know what patients want and need? The typology reveals that models are neither entirely compatible nor entirely incompatible and may be usefully combined in certain practices and policies. In other instances, internal contradictions may jeopardize the realization of coherent patient-centered care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. American Academy of Family Physicians (AAFP), American Academy of Pediatrics, American College of Physicians, & American Osteopathic Association. (2007). Joint principles of the patient-centered medical home. Available at http://www.acponline.org/hpp/approve_jp.pdf. Accessed Mar 10, 2013.

  2. Balint, E., Ball, D., & Hare, M. (1969). Training medical students in patient-centered medicine. Comprehensive Psychiatry, 10(4), 9.

    Article  Google Scholar 

  3. Barry, M. J., & Edgman-Levitan, S. (2012). Shared decision making: The pinnacle of patient-centered care. New England Journal of Medicine, 366, 780–781.

    Article  CAS  PubMed  Google Scholar 

  4. Bartz, R. (1999). Beyond the psychosocial model: New approaches to doctor–patient interactions. Journal of Family Practice, 48(8), 601–607.

    CAS  PubMed  Google Scholar 

  5. Berwick, D. M. (2009). What “patient-centered” should mean: Confessions of an extremist. Health Affairs, 28(4), w555–w565.

    Article  PubMed  Google Scholar 

  6. Bodenheimer, T., & Grumbach, K. (2012). Understanding health policy: A clinical approach (6th ed.). New York: Lange.

    Google Scholar 

  7. Boyd, C. M., Darer, J., Boult, C., Fried, L. P., Boult, L., & Wu, A. W. (2005). Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: Implications for pay for performance. JAMA, 294(6), 716–724.

    Article  CAS  PubMed  Google Scholar 

  8. Brody, H. (1999). The biopsychosocial model, patient-centered care, and culturally sensitive practice. Journal of Family Practice, 48(8). Available at http://www.jfponline.com/Pages.asp?AID=2680. Accessed Sept 12, 2012.

    Google Scholar 

  9. Cassell, E. J. (1991). The nature of suffering and the goals of medicine. New York: Oxford University Press.

    Google Scholar 

  10. Cebul, R., Rebitzer, J., Taylor, L. J., & Votruba, M. (2013). Organizational fragmentation and care quality in the US health care system. In E. Elhauge (Ed.), The Fragmentation of US Health Care: Causes and Solutions. New York: Oxford University Press.

    Google Scholar 

  11. Center for Medicare and Medicaid Services (CMS). (n.d.). Bundled payments for care improvement (BPCI) initiative: General information. Available at www.innovation.cms.gov/initiatives/bundled-payments/. Accessed Mar 11, 2013.

  12. Charles, C., Gafni, A., & Whelan, T. (1997). Shared decision-making in the medical encounter: What does it mean (or it takes at least two to tango). Social Science and Medicine, 44(5), 681–692.

    Article  CAS  PubMed  Google Scholar 

  13. Charon, R. (2006). Narrative medicine: Honoring the stories of illness. New York: Oxford University Press.

    Google Scholar 

  14. Colton, C. W., & Manderscheid, R. W. (2006). Conguencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Preventing Chronic Disease, 3(2), 1–14.

    Google Scholar 

  15. Dean, A. L., Lambrese, J., Dollase, R., Feller, E., & Taylor, J. S. (2011). Successful implementation of an LGBTQI health elective into a medical school curriculum: A tool to increase culturally sensitive care in person-centered medicine. International Journal of Person-Centered Medicine, 1(4), 830–838.

    Google Scholar 

  16. Elhauge, E. (Ed.). (2010). The fragmentation of US health care: Causes and solutions. New York: Oxford University Press.

    Google Scholar 

  17. Elwyn, G., Frosch, D., & Rollnick, S. (2009). Dual equipoise shared decision-making: Definitions for decision and behaviour support interventions. Implementation Science, 4. Available at http://www.implementationscience.com/content/4/1/75. Accessed Jan 12, 2013.

  18. Engel, G. L. (1980). The clinical application of the biopsychosocial model. American Journal of Psychiatry, 137(5), 535–544.

    Article  CAS  PubMed  Google Scholar 

  19. Enthoven, A. C. (2009). Integrated delivery systems: The cure for fragmentation. American Journal of Managed Care, 15(10), S284–S290.

    PubMed  Google Scholar 

  20. Epperly, T. (2012). Person-centered medical education: North American approaches. International Journal of Patient-Centered Medicine, 2(1), 38–42.

    Google Scholar 

  21. Epstein, R. M. (2000). The science of patient-centered care. Journal of Family Practice, 49(9). Available at http://www.jponline.com/Pages.asp?AID=2593. Accessed Sept 15, 2012.

    Google Scholar 

  22. Future of Family Medicine Project Leadership Committee (FFMPLC). (2004). The future of family medicine: A collaborative project of the family medicine community. Annals of Family Medicine, 2(suppl. 1), s3–s32.

    Article  Google Scholar 

  23. Gabler, N. B., Duan, N., Liao, D., Elmore, J. G., Ganiats, T. G., & Kravitz, R. L. (2009). Dealing with the heterogeneity of treatment effects: Is the literature up to the challenge? Trials, 10, 43.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Ghaemi, S. N. (2009). The rise and fall of the biopsychosocial model. British Journal of Psychiatry, 195, 3–4.

    Article  PubMed  Google Scholar 

  25. Goroll, A. H., Berenson, R. A., Shoenbaum, S. C., & Gardner, L. B. (2007). Fundamental reform of payment for adult primary care: Comprehensive payment for comprehensive care. Journal of General Internal Medicine, 22(3), 410–415.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Grob, R. (2012). The heart of patient-centered care. Journal of Health Politics, Policy and Law 1966406 (published ahead of print December 21).

  27. Groopman, J. (2007). How doctors think. New York: Houghton Mifflin.

    Google Scholar 

  28. Groopman, J., & Hartzband, P. (2011). Your medical mind: How to decide what is right for you. New York: Penguin.

    Google Scholar 

  29. Gruman, J. (2011). Remarks at the third annual comparative effectiveness summit, Washington, D.C., October.

  30. Herzlinger, R. (1999). Market-driven health care: Who wins, who loses in the transformation of America’s largest service industry. New York: Perseus Books.

    Google Scholar 

  31. Isaacs, S. L., & Knickman, J. R. (Eds.). (2004). Generalist medicine and the US health system. San Francisco: Jossey-Bass.

    Google Scholar 

  32. Kaiser Family Foundation (KFF). (2011a). Medicaid’s new “health home” option. Available at http://www.kff.org/medicaid/upload/8169.pdf. Accessed Feb 20, 2013.

  33. Kaiser Family Foundation (KFF). (2011b). Summary of the new health reform law. Available at http://www.kff.org/healthreform/upload/8061.pdf. Accessed Jan 15, 2013.

  34. Kaiser Family Foundation (KFF). (2013). Money Follows the Person: A 2012 survey of transitions, services and costs. Available at http://www.kff.org/medicaid/upload/8142-03.pdf. Accessed Mar 11, 2013.

  35. Kleinman, A., Das, V., & Lock, M. (Eds.). (1997). Social suffering. Berkeley: University of California Press.

    Google Scholar 

  36. Klein, E. (2013). If this was a pill, you'd do anything to get it. Available at www.washingtonpost.com/blogs/wonkblog/wp/2013/04/28/if-this-was-a-pill-you'd-do-anything-to-get-it/. Accessed June 17, 2013.

  37. Longworth, D. L. (2011). Accountable care organizations, the patient-centered medical home, and health care reform: What does it all mean? Cleveland Clinic Journal of Medicine, 78(9), 571–582.

    Article  PubMed  Google Scholar 

  38. McKinlay, J., & Marceau, L. (2008). When there is no doctor: Reasons for the disappearance of primary care physicians in the US during the early 21st century. Social Science and Medicine. doi:10.10.16/socscimed.2008.06.034.

  39. Miles, A., & Mezzich, J. E. (2011). The care of the patient and the soul of the clinic: Person-centered medicine as an emergent model of modern clinical practice. International Journal of Person-Centered Medicine, 1(2), 207–222.

    Google Scholar 

  40. National Coalition for Mental Health Recovery (NCMHR). (n.d.). Available at http://ncmhr.org/recovery.htm. Accessed Mar 2, 2013.

  41. National Committee for Quality Assurance (NCQA). (n.d.). Patient-centered medical home. Available at http://www.ncqa.org/Programs/Recognition/PatientCenteredMedicalHomePCMH.aspx. Accessed Mar 12, 2013.

  42. Norsigian, J., Diskin, V., Doress-Worters, P., Pincus, J., Sanford, W., & Swenson, N. (1999). The Boston Women’s health book collective and our bodies, ourselves: A brief history and reflection. Journal of the American Medical Women’s Association, Winter. Available at http://www.ourbodiesourselves.org/about/jamwa.asp. Accessed Jan 27, 2013.

  43. Oana Groene, R., Bolibar, I., & Brotons, C. (2012). Impact, barriers and facilitators of the “Ask Me 3” Patient Communications Intervention in a primary care center in Spain: A mixed-methods analysis. International Journal of Patient-Centered Medicine, 2(4), 853–861.

    Google Scholar 

  44. O’Connor, A. M., Wennberg, J. E., Legare, F., Llewellyn-Thomas, H. A., Moulton, B. W., Sepucha, K. R., et al. (2007). Toward the “tipping point”: Decision aids and informed patient choice. Health Affairs, 26(3), 716–725.

    Article  PubMed  Google Scholar 

  45. Parks, J., Svensen, D., Singer, P., & Foti, M. E. (Eds) (2006). Morbidity and mortality in people with serious mental illness. National Association of State Mental Health Program Directors. Available at http://www.dsamh.utah.gov/docs/mortality-morbidity_nasmhpd.pdf. Accessed Mar 1, 2013.

  46. Patient-Centered Outcomes Research Institute (PCORI). (n.d.). Research we support. Available at http://www.pcori.org/research-we-support/pcor/. Accessed Mar 12, 2013.

  47. Patient Centered Outcomes Research Institute (PCO RI). (2013). Funding announcement: Improving healthcare systems. Available at http://www.pcori.org/assets/PFA-Improving-Healthcare-Systems.pdf. Accessed Feb 20, 2013.

  48. Rubin, J. (2012). Right turn: Paul Ryan interview, Part 2. Washington Post, May 10. Available at http://www.washingtonpost.com/blogs/right-turn/post/paul-ryan-interview. Accessed Mar 10, 2013.

  49. Ruzek, S. (2007). Transforming doctor–patient relationships. Journal of Health Services Research and Policy, 12(3), 181–182.

    Article  PubMed  Google Scholar 

  50. Shih, A., Davis, K., Schoenbaum, S., Gauthier, A., Nuzum, R., & McCarthy, D. (2008). Organizing the U.S. health care delivery system for high performance. The Commonwealth Fund. Available at www.commonwealthfund.org/Publications/Fund-Reports/2008/Aug/Organizing-the-U-S--Health-Care-Delivery-System-for-High-Performance.aspx. Accessed Feb 4, 2013.

  51. Shrestha, S., Armento, M. E. A., Bush, A. L., Huddleston, C., Zeno, D., Jameson, J. P., et al. (2012). Pilot findings from a community-based treatment program for late-life anxiety: Implications for person-centered medicine. International Journal of Person-Centered Medicine, 2(3), 400–409.

    Google Scholar 

  52. Skinner, J. (2011). Understanding prices and quantities in the US health care system. Journal of Health Politics, Policy and Law, 36(4), 791–801.

    Article  PubMed  Google Scholar 

  53. Stange, K. C. (2009). The problem of fragmentation and the need for integrative solutions. Annals of Family Medicine, 7(2), 100–103.

    Article  PubMed Central  PubMed  Google Scholar 

  54. Starfield, B., Shi, L., & Macinko, J. (2005). Contribution of primary care to health systems and health. Milbank Quarterly, 83(3), 457–502.

    Article  PubMed Central  PubMed  Google Scholar 

  55. Stevens, D. (2011). The evolution of the primary care medical home. Community Health Forum (Winter/Spring), 22–33.

  56. Substance Abuse and Mental Health Services Administration (SAMHSA). (n.d.). Primary and behavioral health care integration. Available at http://www.integration.samhsa.gov/PBHCI_Program_Profile_2012.pdf. Accessed Mar 1, 2013.

  57. Tanenbaum, S. J. (2013). Reducing variation in health care: The rhetorical politics of a policy idea. Journal of Health Politics, Policy and Law, 38(1), 5–26.

    Article  PubMed  Google Scholar 

  58. Tarter, R. E., Kirisci, L., Ridenour, T., & Bogen, D. (2012). Application of person-centered medicine in addiction. International Journal of Person-Centered Medicine, 2(2), 240–249.

    Google Scholar 

  59. Tomes, N. (2006). The patient as a policy factor: A historical case study of the consumer/survivor movement in mental health. Health Affairs, 25(3), 720–729.

    Article  PubMed  Google Scholar 

  60. Toombs, S. K. (1993). The meaning of illness: A phenomenological account of the different perspectives of physician and patient. Dordrecht: Kluwer Academic Publishers.

    Google Scholar 

  61. Wennberg, J. E. (2010). Tracking medicine: A researcher’s quest to understand health care. Oxford: Oxford University Press.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sandra J. Tanenbaum.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tanenbaum, S.J. What is Patient-Centered Care? A Typology of Models and Missions. Health Care Anal 23, 272–287 (2015). https://doi.org/10.1007/s10728-013-0257-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10728-013-0257-0

Keywords

Navigation