Moving Toward Patient-centered Care Could Improve Clinical Outcomes

NEW ORLEANS – A new method of care could improve patient satisfaction, retention and outcomes over standard methods, according to research presented at the American Academy of Orthotists and Prosthetists Annual Meeting, here.

Patient-centered care

It is called “patient-centered care,” and it revolves around the preferences and values of the patient, rather than the clinician, George Gondo, MA, director of research and grants for the Amputee Coalition, said.

“A lot of times the provider dominates the discussion…but instead of making the patient passive, our system respects their ideas, gets them involved and makes the process more collaborative.”

It is tailored to individual needs, he said, recognizing that each patient has specific post-amputation goals and ideas about the type of care they should receive.

“It shifts the dynamic away from the provider, away from evidenced-based type medicine and places more control within the hands of the patient.

“That does not mean we throw clinical measures out the window, but we have to focus on the patient’s experience with an illness and not just the illness itself.”

‘The particular world of amputation’

Focusing on the patient could improve overall care, “but what does it mean to the particular world of amputation?” Gondo asked.

He and a team of researchers conducted a 5-month survey to investigate. The online questionnaire included 270 respondents, looked at what amputees expect from their prosthetists and examined whether the method of delivering care impacted patient behavior.

Findings showed that patient-perceived outcomes improved when care was specifically tailored to them, rather than “cookie cutter clinical measures,” Gondo said.

George Gondo

“They may not care about how they perform on a timed up and go test, or a 6-minute walk test or the AMPPRO,” he said. “They may want to play with their kids in the backyard…to do the things they want to do.”

Researchers found that when prosthetists do not listen to patients’ concerns or rehabilitation goals, the patient could likely switch providers. A total of 51% of respondents said they switched providers in the past, with 88% of those switching up to three times.

“The patients that switched indicated what factors weighed in their decision,” Gondo said. “The first one was that their prosthetist could not get the device to fit to satisfaction. But the other one is that their provider did not listen to their concerns.

“Simply listening to the patient might be a factor in retaining them over time. Finding out what questions are most important to them and asking about the outcomes and type of rehabilitation they are looking for [are also important]. If you do not ask what they expect, you cannot really do much to help them.”

Educating the patient also plays a role in positive outcomes, the researchers found. Patients often rely on their prosthetist to connect them with other aspects of care, such as physical therapy or peer support.

“Offering information and communicating about options may allow them to make essential decisions,” Gondo said. “Patients sometimes think they know what they want because they see an ad in a magazine or on TV, but as a provider, you have to educate them about what a particular resource or option means.”

Future directions

Patient-centered care stems beyond just listening to the patient, he added. Involving the patient from the beginning, integrating multiple aspects of care and including family members or friends could predict long-term success. It could also have implications on the overall health care system, he said.

“This idea of personalized care…is inextricably linked with health care reform. It is essential to the broader conversation about outcomes and how they will be delivered in the future.”

While clinical outcomes are important, providers must change the focus of research to meet the values of their patients. “Because ultimately, the patients are what is most important,” Gondo said. – by Shawn M. Carter


Gondo G, et al. Paper F38. Presented at: American Academy of Orthotists and Prosthetists Annual Meeting and Scientific Symposium; Feb. 18-21, 2015; New Orleans.

Disclosure: Gondo reports the project was supported in part by cooperative agreement number, 5U59DD000904-02, through the CDC. Its contents are the sole responsibility of the Amputee Coalition and do not necessarily represent the official views of the CDC or the Department of Health and Human Services.

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