Mr. Hypothetical visits the doctor for an ailment. His doctor’s diagnosis is spot-on, the treatment plan comprehensive – but he has a less than positive outcome. Why?
It turns out Hypothetical was unable to afford the range of medicines his doctor prescribed. Plus, his car was in the shop for another week, so he wouldn’t be able to attend physical therapy. He never set up an appointment with a specialist for the same reason, and his referral window closed.
Contextual errors, a term coined by Saul J. Weiner, MD, of the Institute for Health Research and Policy at the University of Illinois, are clinical failures to spot issues like financial or emotional difficulties that may prevent a patient from following a treatment plan – paying for medicine, for example, or physical deterioration, or life stress that just won’t allow room for solving yet another problem.
In one recent study Weiner led, addressing measured contextual factors improved health care outcomes in 71% of patients studied, compared with 46% of those with factors not addressed.
Weiner is exploring and identifying ways to improve how physicians individualize treatment decisions, including studies on how well clinicians retain information from patient interactions. The goal is to move healthcare to widely adopt what’s become known as “patient-centered decision making.”
As well as improving clincian-patient interactions, other interventions may include human help along each step of a care plan. Accolade has built a growing business of providing personal health assistants to the employees (and their families) of large self-insured companies. The assistants, about two-thirds of whom are nurses or social workers, work one-on-one with employees and their families to walk them through benefits and care decisions.
Alan Spiro, MD, Accolade’s Chief Medical Officer, says taking a broad view of a patient’s circumstances is key to helping him or her stay well or heal.
“When I was a doctor I quickly learned that a critical issue for my patients was not just the proper diagnosis; it was also all of the other factors in their lives when they had to deal with that illness. The psychosocial, financial and spiritual elements that are so critical to living become harder when you or a family member is sick,” he says.
The company has done much research on the process of healthcare decision making to identify why questionable decisions or wasteful care happens, he says. Financial constraints are among the reasons many patients reach out for assistance. These issues, coupled with barriers like transportation and work or family obligations, if not addressed, can contribute to overly hasty and emotion-laden decisions.
“Lower-income patients may call because they don’t understand their benefits and don’t know what something is going to cost them. We get calls literally from the parking lot of emergency rooms asking about benefits,” he says.
Accolade has seen a large reduction in hospital readmission rates, which they attribute to health assistants’ frequent check-ins with recently released patients.
“In the real world, people leave the hospital sick – you’re just not sick enough for hospital care. You’re frightened; you often feel alone. Maybe you don’t go to the pharmacy or for follow-up appointments,
” Spiro says.
Doctors Spiro and Weiner will be our special guests for this week’s Great Challenges Google+ Hangout: Connecting the Dots in Patient-Centered Care. Join us Thursday December 5 at 2PM ET for this live online event. Tweet questions to #GreatChallenges and we’ll answer as many as we can on air. Sign up today or learn more.