ADEA CCI Liaison Ledger

Author Interview: CCI 2.0 White Paper Examines Person-centered Care

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Liaison Ledger: What were your goals in writing a white paper on person-centered care?
Nadeem Karimbux: The goal of this paper is to engage the dental education community in the thought process around the different components of person-centered care and to see if the community can come up with the kinds of tools that are needed to implement some of these practices and share them with the wider dental community.

Muhammad Walji: This was really an exciting paper for all of us to work on because it paints the future of clinical care, especially how individuals and their families will receive and participate in care in the future, with the goal that the care delivered is going to be of higher quality, more cost effective and much more convenient. 

Liaison Ledger: What most excites you about person-centered care? 
Muhammad Walji: We now have a lot more information on individuals—their preferences, their biological data, their genes. It could be as simple as collecting tooth-brushing or flossing data on a patient. Right now that data is very siloed. It’s used by the patient, but it’s not fully integrated into our health care system. 

The whole dental community has some great opportunities ahead of us to be fully involved in determining this person-centered care future—really molding how our patients will receive care, how our students are going to be trained to make sure that they can deliver that care, and then how our academic dental institutions are going to need to be set up to support all of these things.

Andrew Spielman: Many of the competencies that drive curriculum are really student-centered, and they are essentially addressing the student’s needs as opposed to the patient’s needs. 

Nadeem Karimbux: We spend so much time in our schools thinking about how to make our patient care and our clinical operations more efficient. A lot of the inefficiency is created because we ask our students to complete certain procedures on patients to show that they’re competent on those procedures. That’s what Andrew’s getting at. The way we assess our students creates a very student-centered care experience. The patients become a requirement for the students in order to complete their dental degrees.

Andrew Spielman: Person-centered care gives comfort in knowing that you—not the physician’s or dentist’s need to complete a requirement—are the focus of care. There is something called a sociome, which is now starting to emerge. It’s the idea that social circles are important for individuals’ well-being and their health. So in person-centered care, the sociome is an element that will be considered in addition to all the biological things. The sociome was something that people didn’t really consider. You walked in and the health care provider said, “This is the ideal treatment. This is what you can afford. Let’s choose one or the other.” But the decision was not necessarily made with a full consideration of what the patient really wanted or with the patient’s family and others involved in making a collective decision. 

Liaison Ledger: What will be the most challenging aspect of implementing person-centered care for dental programs?
Muhammad Walji: Dentistry is still a cottage industry that is not fully integrated into the health care system. Payment for oral health care is an example of that. Person-centered care is about looking not just at issues in the mouth, but at issues in the whole body. If dentistry remains separated from the rest of the health care delivery system, it’s going to be a problem for us to go toward a more holistic model of person-centered care.

Andrew Spielman: Just to add on that, person-centered care will essentially push dental clinical care into a more interprofessional mode—something that we are striving for, but we’re not yet there. Ultimately interprofessional care will be the future, and those that make that transition will have a far easier time surviving many of the other challenges that are awaiting dental education. 

Nadeem Karimbux: Changing the culture of what faculty and departments and divisions do to ensure that students are technically sound in all the various ways will be the biggest obstacle to implementing person-centered care in dental programs. The things that we’re talking about are going to have implications in terms of the way that we set up our clinics, the way we run them and the infrastructure that we’re going to have to provide from a technology perspective. So it’s not only about changing the human culture.

Muhammad Walji: We often see in other industries how change occurs because of pressure from consumers. As our patients consume other services in banking and finance and buying things online, their expectations are going to be different. Those attitudes will be a driving force that helps catalyze this change in health care delivery. The whole idea behind person-centered care is that we’re redesigning how people consume health care—not based on the convenience of the health care providers or the institutions, but based on the needs of the individuals and their families. 

Liaison Ledger: Do you see other drivers that you think will push us toward person-centered care delivery?
Andrew Spielman: Traditionally, dental insurance was completely separate from medical insurance. That is changing. The trends suggest that dental insurance has to be part of medical insurance. Kaiser Permanente did a study with 11 million people in which they looked at the benefit of doing scaling and root planing, and they found that, over time, they can save billions of dollars related to avoided complications of diabetes and reduced medical care. Person-centered care is also better care, and therefore, insurance will look at it as a way to save long term. Insurers allocate funds for prevention because they see the benefits down the line.

Muhammad Walji: In our manuscript, we talk about value-based payments. This whole movement away from paying health care providers for doing procedures toward actually paying them for preventing disease or treating disease in a high-quality and highly efficient manner, is going to be inevitable for dentistry. It is much more person-centered than our current fee-for-service model.


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