Person-centered medicine: currents and crosscurrents in the United States

Abstract

In their editorial introduction to an earlier issue of the International Journal of Person-Centered Medicine, Miles and Mezzich cite positive developments in the United States and United Kingdom. The creation, in the U.S., of the Patient-Centered Outcomes Research Institute (PCORI) is rightly portrayed by these authors as focusing serious attention on the needs of patients for meaningful information about their medical care. PCORI is in some ways--for example, in its apparent commitment to stakeholder engagement and methodological innovation - a departure from earlier public and private efforts to create an evidence base for medical practice. On the other hand, PCORI’s roots and much of the current discourse about its future reflect a residual hold by evidence-based medicine (EBM) on healthcare research and policy-making. First, PCORI was established primarily to promote the conduct of CER, the appetite for which derived from the demand for effectiveness research generally. Second, the patient-centeredness of PCORI is manifest primarily in the conduct of research rather than the process of care. Third, patient-centeredness is commonly taken to refer to patients as a group - as opposed to, say, physicians or researchers as a group -rather than to individual patients. Fourth, it will be difficult and expensive for PCORI to attend to heterogeneity of treatment effects. Fifth and perhaps most important, the creation of PCORI is contemporaneous with other, countervailing, developments in the U.S. healthcare system.