The Context of Use Perspective

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There are three different contexts of use. The differentiating characteristics are: the level of complexity and the duration for which the type of [care] plan is used/remains active.

Level 1

This is the simplest of all the types of plan used with limited scope and complexity.

(Note: It is often referred to as "treatment plan")

The Subject/Target

• Patient/subject of care

The Author(s)

• Patient's primary care provider/general practitioner
• Patient's specialist provider in clinic or hospital practice

Scope and Complexity

• Provider centric
• Problem-oriented
• May be part of SOAP documentation
• Within boundary of single disciple and single care setting/organization

Timeframe/Duration of Use

• Encounter-based (i.e. a new/different plan is generated per encounter)
• Or problem-based (i.e. the same plan may get revised on subsequent encounter/visit until problem requiring care is resolved)

Level 2

This type of plan is used in managing patients with more complex conditions during an episode of care (usually of limited duration)

(Note: This type of plan is often referred to as "care plan" or "plan of care")

The subject/target

• The patient/subject of care

The author(s)

• The patient's health care provider(s), or health care team

The Scope and Complexity

• Specialty-centric
• Problem-oriented: involving one or more problems
• Across multiple disciplines/departments (e.g. involving treating physicians/surgeons, nurses, allied health providers, social workers)
• Within the boundary of same health care setting/organization
• May be used as care coordination tool within the boundary of same health care organization

Timeframe/Duration

• Problem(s)-based: plan in use and subjected to changes in response to changing patient condition
• Episode of care-based: plan in use until the episode of care (e.g. hospitalization) is completed

Level 3

This is the most complex form of plan used for coordinating the care/management of patient with multiple and complex chronic conditions.

(Note: It is also known as "care plan", "shared care plan", or "comprehensive care plan").

The Subject/Target

• the patient/subject of care
• the family/significant others

The author(s)

• The healthcare team
• The patient/family

The Scope and Complexity

• Patient/consumer-centric
• Problem(s)-oriented: health problems are complex and chronic
• Across multiple-discipline, multiple care settings/organization boundaries
• Used as care coordination tool across care setting boundaries for managing multiple, complex health problems/conditions

Timeframe/Duration

• longitudinal/lifelong (for duration of lifespan of chronic condition)

Patient-centric and Provider-centric

• Patient-centered health care is defined as:

- "Health care that establishes a partnership among practitioners, patients, and their families (when appropriate) to ensure that decisions respect patients' wants, needs, and preferences and that patients have the education and support they need to make decisions and participate in their own care"

(Institute of Medicine. Envisioning the National Health Care Quality Report. Washington, DC: National Academies Press; 2001)

- "Patient centeredness "encompasses qualities of compassion, empathy, and responsiveness to the needs, values, and expressed preferences of the individual patient."

Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academies Press; 2001

- In addition, translation and interpretation services facilitate communication between the provider and the patient and are often a legal requirement.i The patient-centered approach includes viewing the patient as a unique person, rather than focusing strictly on the illness, building a therapeutic alliance based on the patient's and the provider's perspectives"

http://www.ahrq.gov/research/findings/nhqrdr/nhdr10/Chap5.html

- In the case of patient-centric "care plans", this means that the "care plans" are designed/developed in partnership with the patient and/or patient family, taking into full consideration of the patient's and family needs, wishes and preferences. The patient is a responsible member of the care team.

• Provider/Physician-centered health care:

- Health care that is determined/controlled mainly by the health care providers/physicians in charge of the care of the patient or consumer. The role of patient/consumer in determining the type of health care is likely to be minimal.

- In the case of provider-centric "care plans", this means that the provider assumes the sole responsibility of developing the "care plans" for the management of the patient's condition(s)/health issue(s). The patient's and/or family's wishes, needs, preferences are taken into consideration, subjected to the professional judgment of the health care provider responsible for the care of the patient.