HCA 675 What do you see as the conflicts between customizing patient care to the needs of an individual patient and standardizing care based on research?

There can be several pertinent conflicts between customizing patient care to the needs of an individual and standardizing care based on research. Standardization of care stems from evidenced-based medicine (EBM) and uses research to establish clinical practice guidelines (Ansmann & Pfaff, 2018). While this is accepted by the majority of providers and organizations as an effective way to conduct care, there are several concerns around using standardized medicine for all populations. Ansmann & Pfaff (2018) discuss these concerns, which include that precision medicine has increased with technology and diagnostics, there is an increase in multimorbid patients that are not accounted for in standard practice guidelines, and there is increase in shared decision-making. These growing trends are not supported by EBM, yet are with personalized and individualized care. Tailoring care to the patient based on psychosocial, cultural, and patient preferences can be defined as customized medicine (Ansmann & Pfaff). This is slightly different from personalized medicine, which is the “adaptation of treatment to the biological dimensions of the patient’s body” (Ansmann & Pfaff, 2018, p. 349). It appears that the benefits of a customized approach can include personalization of treatment, which aligns with the precision medicine trend. Overall, the conflicts between these approaches will like grow as technology advances and population trends change. A good solution may be to continue evidenced-based research but start to include factors that are more present in today’s population.

Reference

Ansmann, L., & Pfaff, H. (2018). Providers and Patients Caught Between Standardization and Individualization: Individualized Standardization as a Solution Comment on “(Re) Making the Procrustean Bed? Standardization and Customization as Competing Logics in Healthcare”. International journal of health policy and management, 7(4), 349–352. https://doi.org/10.15171/ijhpm.2017.95

Hi Amber, you make interesting points concerning the conflicts between research based standardized care and individualized care. The adoption of evidence-based medicine as supported by standardized care based on research has gained traction in the healthcare field. Its application has certain advantages such as precision medicine and use of effective interventions (Ansmann & Pfaff, 2018) However, the adoption of such an approach conflicts with the personalization of care as the former does not support individualized care. As such, all the patients are assumed to have the same characteristics, which may impact the effectiveness of the method. As regards individualized care, the interventions are tailored to ensure that each patient’s characteristics are leveraged during the care process.

References

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Re: Topic 5 DQ 1

Customizing patient care is becoming more frequent with patients demanding care that is specifically tailored to them vs. the population. With many organizations touting shared decision-making and encouraging patients to be an integral part of team-based care, patients are accepting this role and becoming more informed and actively involved. Additionally, to build rapport and establish trust, physicians may reluctantly comply.

Research of Pfaff et al., (2010), found ‘“Individualized standardization of care ‘is defined as the imposition of standards, regulations or norms which are tailored to the genes, body condition, culture, social environment, values, needs and preferences of the individual patient” (Ansmann & Pfaff, 2018, p. 350). Although evidence-based research (EBR) supports a different path, or treatment plan, it appears that through marketing efforts by companies and organizations, the patient seems to have the upper hand in this situation. This could be due to personalized medicine (concierge medicine/services, the use of biomarkers or phenotypic traits seen in genetic testing, etc.). According to Michael Field, CEO of the Raymond Corporation states, “It comes back to being very customer-centric, striving for innovation, striving for quality, and providing service like nobody else” (Blanchard, 2016, p. 12). Patient-centric care has become the focus for health care organizations (HCO’s) and a strategic approach to remain competitive in a dynamic, often turbulent market. HCO’s are attempting to get patients to be involved in their care because they are then more willing to follow treatment plans when empowered to do so.

HCA 675 What do you see as the conflicts between customizing patient care to the needs of an individual patient and standardizing care based on research

Research of Barratt (2008) discovered the trend to “Patient care is increasingly customized or personalized as a result of three trends. 1) growing scientific knowledge facilitates precision medicine due to highly specific individual diagnostics and tailored therapies (Dzau & Ginsburg, 2016; Fierz 2004), 2) the increasing number of multimorbid patients urges deviation from evidence-based guidelines, and 3) patient empowerment urges shared decision-making between provider and patient (Barratt, 2008).

(Ansmann & Pfaff, 2018, pp. 349-350).

Conflict occurs when personalization competes with standardized evidenced-based medicine (EBM). When patients are unwilling to consent to EBM, preferring a different route that may be more costly and complex, physicians become middlemen as their practice negotiates with payors (insurance companies, HMO’s, Medicaid, Medicare etc.) to pay for these services that “deviate” from what has been recommended (Ansmann & Pfaff, 2018, p. 351). It is finding the right balance, whether providing the patient more information on what research supports as well as respecting patient autonomy and acquiescing to their wishes.

References:

Blanchard, D. (2016). The Key to Success Is Staying Focused on the Customer. Material Handling & Logistics, 71(6),

Kimberly, thank you for a magnificent post on the conflicts between the personalized care and standardized evidence-based care. Indeed, personalized care leverages the traits of a patient such as their genes to create interventions. The thinking behind this is found in the fact that patients should have a say in what interventions should be adopted (Ansmann & Pfaff, 2018). However, the EBM oriented standardized care bases its operations on clinical guidelines. As such, patients do not influence the care process. This conflict is important as it may impact the recovery process of a patient based on their preference.

HCA 675 What do you see as the conflicts between customizing patient care to the needs of an individual patient and standardizing care based on research?