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Systematic Conceptualization of Person Centered Medicine and Development and Validation of a Person-centered Care Index

Juan E Mezzich, Levent Kirisci, Ihsan Salloum, Jitendra Trivedi, Sujit Kumar Kar, Neal Adams, Janet Wallcraft

Abstract


Background: A world-wide movement is emerging for person centered medicine and healthcare collaboratively developed by the International College of Person Centered Medicine and a number of global institutions through annual Geneva Conferences and International Congresses as well as scholarly publications. While frequently quoted definitional note have been advanced through this maturational process, efforts are needed to conceptualize and measure systematically person-centered care.

Objectives: These included the elucidation of the core concepts of person centered medicine and healthcare, the design of a prototype measuring instrument, and the study of its metric structure, acceptability, reliability and validity.

Methods: The following methodological approaches were employed: A systematic review of the literature, consultation exercises with broad international panels composed of health professionals and representatives of patient and family organizations, and quantitative and qualitative data analyses.

Results: The following key concepts underlying person centered medicine were elucidated: 1) Ethical Commitment, 2) Cultural Sensitivity, 3) Holistic scope, 4) Relational Focus, 5) Individualized Care, 6) Common Ground for Collaborative Diagnosis and Care, 7) People-centered Systems of Care, and 8) Person-centered Education and Research. On this basis, a Person-centered Care Index was developed composed of 8 broad items and 33 sub-items, each measured on a 4-point scale. The study of its metric structure revealed high Cronbach internal consistency (0.95), scale unidimensionality through factor analysis (69 % of the variance accounted for by the first factor), and interesting inter-correlations such as the sub-item attaining the highest correlation with the global average score being “fulfillment of the person’s life project” (0.88). Validation studies in California, London and Lucknow (India) showed quite high levels of inter-rater reliability (above 0.80 intra-class correlations for most items) and substantial content validity.

Discussion: The elucidated core concepts of person centered medicine appear to be consistent with those of international studies on the bases of person- and people-centeredness in primary care and on research and implementation of person centered care. The concepts are also consistent with the key domains of person-centered diagnostic approaches. Further validation studies with larger samples in diverse settings and cultures seem to be warranted.

Conclusions. The emerging core concepts of person centered medicine appear to be solid. The Person-centered Care Index built on such concepts appears to have suitable metrics and promising acceptability, reliability and content validity. Further empirical research is recommended.


Keywords


Person Centered Medicine, Conceptualization, Measurement, Metrics, Principles, Geneva Conferences, International Network of Person Centered Medicine, International College of Person Centered Medicine, People-centered Care, Instruments, Validation

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References


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DOI: http://dx.doi.org/10.5750/ijpcm.v6i4.610

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