Transparency, empowerment, and activation can be supported by institutionalizing the mutual creation of the treatment plan that guides patients’ care in their primary care setting and in the health system more generally. The desire of patients to participate in creating the documentation of their care that emerged in the pilots of open notes can be addressed care through a process called a patient-centered care plan. A care plan is a brief distillation of the information that is needed to inform a successful treatment. For multiply-disadvantaged patients, who are likely to have a history of difficult experiences in the healthcare system, knowledge of the patients’ hopes about the ways that their health teams should relate to them, when shared with any internal or extended team member, can help to keep partnership intact through difficult or upsetting times. When done well, multiple members of the team are involved in creating a document that reflects the patients’ ideas and values on which a successful relationship would be built. The creation and utilization of the PCCP become a crucial experience in building partnership for both patients and health professionals.
KeywordsComplex patients Patient-centered Care plans Patient participation Patient empowerment Team-based care Healthcare reform
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