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Evidence-Based Practice and Patient-Centered Care: Doing Both Well

Engle RL, Holmes SK, Mohr DC, Seibert MN, Leyson J, Afable M, Meterko MM. Evidence-Based Practice and Patient-Centered Care: Doing Both Well. Paper presented at: AcademyHealth Annual Research Meeting; 2015 Jun 15; Minneapolis, MN.




Abstract:

Research Objective: Healthcare organizations are increasingly striving to deliver care that is both evidence based and patient centered. These aims are often complementary. However, fundamental contradictions exist between these goals, and the organizational culture and infrastructure necessary to be successful in one domain may inherently diminish performance in the other. This study expands the understanding of the relationship between evidence-based practice (EBP) and patient-centered care (PCC) by answering the following questions: 1) What are the key characteristics that distinguish facilities that are able to provide inpatient care that is both evidence-based and patient-centered from facilities where performance is either mixed or low in both domains? 2) What specific behavioral and process mechanisms distinguish organizations that provide both evidence-based and patient-centered care? Study Design: We conducted site visits at 12 U.S. Department of Veterans Affairs Medical Centers (VAMCs). EBP was assessed by facility-level inpatient quality indicator scores based on medical record reviews; PCC was assessed by facility-level measures based on surveys completed by patients who had recently completed an inpatient stay. The 12 VAMCs selected came from four performance quadrants: High EBP/High PCC, High EBP/Low PCC, Low EBP/ High PCC, and Low EBP/Low PCC. We qualitatively analyzed interview data using a priori constructs consistent with organizational literature, as well as emergent themes. Population Studied: 142 semi-structured interviews were conducted with three categories of staff: 1) medical center senior leadership, 2) physician and nurse mangers, and 3) frontline physicians and nurses. Principal Findings: We identified several differences between facilities that scored high on both EBP and PCC and facilities that scored low on either or both measures. High-performing sites had an active, innovative improvement-oriented culture emphasizing individual accountability and staff engagement in problem solving. Providers at high-performing facilities also had the institutional support and autonomy to provide clinical care that was evidence-based and emphasized patient and family preferences. In addition, high-performing sites took multidisciplinary approaches to care in which members of the team equally shared responsibility for patient care, and communication was open and multidirectional among all levels of the organization, including communication with veterans. In contrast, low-performing sites had passive, punitive cultures in which there was a lack of individual accountability, a blaming culture, and resistance to change. Clinicians in low-performing facilities often aspired to improve clinical performance and patient centeredness, but felt bound by institutional structures and systems that constrained their ability to deliver their preferred level of care.Low-performing sites also had more formalized approaches to providing multidisciplinary care and communication between various levels of the organization was structured or strained. Conclusions: This study generated knowledge about organizational characteristics and behaviors that could be strengthened to facilitate the delivery of care that is both evidence based and patient centered. Implications for Policy or Practice: Recognizing that some characteristics such as culture are difficult to change, these findings nonetheless highlight areas that should be considered when striving to deliver care that is both evidence based and patient centered.





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