View Categories

Patient-Centered Care

21 min read

Introduction #

Patient-centered care (PCC) has emerged as a fundamental pillar of modern healthcare delivery and represents a paradigm shift from traditional disease-focused, paternalistic models toward approaches that integrate patients’ perspectives, needs, and experiences into every phase of medical consultation, treatment, and follow-up [1]. As healthcare systems worldwide evolve to address growing complexity, fragmentation, and persistent health disparities, PCC has been recognized as essential not only for improving individual patient outcomes but also for transforming healthcare delivery at the systems level [2,3].

Health Systems Science (HSS), established as the third pillar of medical education alongside basic and clinical sciences, provides a unified framework for contextualizing healthcare delivery and caring for patients and populations within adaptive health systems [4]. Patient-centered care sits at the intersection of HSS domains, connecting quality improvement, population health, care coordination, and value-based care with the fundamental principle that healthcare must honor and respond to individual patient preferences, needs, values, and goals [5].

Defining Patient-Centered Care #

The Institute of Medicine (IOM) defines patient-centered care as “providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions” [6]. This definition, first formally championed by the Picker Institute in 1988 and later popularized by the IOM’s seminal 2001 report “Crossing the Quality Chasm,” established patient-centeredness as one of six crucial domains of healthcare quality, alongside safety, effectiveness, timeliness, efficiency, and equity [7,8].

The IOM endorsed six dimensions of patient-centered care, originally established by the Picker Institute, which stipulate that care must be: (1) respectful to patients’ values, preferences, and expressed needs; (2) coordinated and integrated; (3) provide information, communication, and education; (4) ensure physical comfort; (5) provide emotional support to relieve fear and anxiety; and (6) involve family and friends [9,10]. These dimensions provide a comprehensive framework for both evaluating and implementing patient-centered care across diverse healthcare settings.

Despite widespread agreement on its importance, consensus on what constitutes PCC remains elusive, with multiple definitions and conceptual models existing in the literature [11,12]. Most providers, policymakers, and researchers agree that PCC represents a shift from traditional, provider-driven and disease-focused approaches toward one that fully integrates the patient’s perceptions, needs, and experiences into healthcare delivery [13]. Mead and Bower’s influential literature review describes PCC as encompassing five conceptual dimensions: the biopsychosocial perspective, patient-as-person, sharing power and responsibility, therapeutic alliance, and doctor-as-person [14].

Core Components of Patient-Centered Care #

Shared Decision-Making

Shared decision-making (SDM) represents the pinnacle of patient-centered care, embodying an interactive, collaborative process where physicians focus on the best scientific evidence while patients contribute their goals, preferences, and values to make healthcare decisions [15,16]. Barry and Edgman-Levitan articulate that the most important attribute of patient-centered care is the active engagement of patients when fateful healthcare decisions must be made, particularly at crossroads where diverging medical options have different and important consequences [17].

Contemporary models of SDM extend beyond traditional decision-making about predetermined treatment options to encompass a broader collaborative approach where patients and clinicians work together to determine the nature of the problematic situation, consider insights that only the patient can share about their biology and biography, and develop sensible care plans based on relevant evidence and patient priorities [18,19]. Research demonstrates that SDM improves patient satisfaction, increases patient knowledge, reduces decisional conflict, and enhances communication between patients and clinicians [20,21]. Systematic reviews indicate that patient decision aids can reduce the prevalence of invasive procedures when patients are fully informed about risks and benefits of various options, while improving health outcomes such as treatment adherence and clinical measures like quality of life [22,23].

Patient-Centered Communication

Effective patient-centered communication serves as the foundation for achieving patient-centered care and represents a critical clinical competence that affects healthcare quality, patient satisfaction, and health outcomes [24,25]. Patient-centered communication has been associated with improved health outcomes including better physiologic measures such as blood pressure and blood glucose levels, improved health status, reduced depression and anxiety, and enhanced functional status with less patient distress [26,27].

A consensus has emerged around six core functions for medical encounters that support patient-centered communication: (1) fostering the relationship, (2) gathering information, (3) providing information, (4) making decisions, (5) responding to emotions, and (6) enabling disease- and treatment-related behavior or self-management [28]. Communication should simultaneously employ a patient-centered approach and interpersonal interaction to promote patient satisfaction, while avoiding overly directive communication patterns that can have negative consequences [29].

Research in psychotherapy contexts demonstrates that patient-centered communication accounts for approximately 30 percent of the variance in symptom improvement and leads to improvements in overall quality of life measures, with patients experiencing higher levels of patient-centered communication reporting significant improvements in functional status and subjective well-being [30]. Furthermore, studies have shown that patient-centered communication increases patient engagement, with effective communication strategies being essential for enabling patients to engage actively in their care [31,32].

Cultural Competence and Health Equity

Cultural competence, defined as the ability of healthcare providers to effectively deliver services that meet the social, cultural, and linguistic needs of patients, intersects significantly with patient-centered care in addressing health disparities and improving healthcare quality [33,34]. The National Standards for Culturally and Linguistically Appropriate Services (CLAS) provide a comprehensive framework for implementing culturally competent care that respects diversity and cultural factors affecting health, including language, communication styles, beliefs, attitudes, and behaviors [35].

Patient-centeredness has theoretical potential to reduce racial and ethnic disparities in healthcare because it addresses some hypothesized mechanisms by which patient race and ethnicity impact healthcare providers, including biases in decision-making and unequal power dynamics between patients and providers [36,37]. Research indicates that bias, stereotyping, prejudice, and clinical uncertainty on the part of healthcare providers contribute to racial and ethnic disparities, with persons in minority groups receiving lower-quality healthcare even when insurance status and ability to pay are equivalent [38,39].

An evolving concept of “cultural humility” emphasizes identifying one’s own implicit biases, cultivating self-understanding and interpersonal sensitivity, and appreciating the multifaceted components of each individual including culture, gender, sexual identity, race, ethnicity, religion, and lifestyle [40]. This concept, combined with cultural competence in what some term “competemility,” requires both process (cultural humility) and product (cultural competence) to interact effectively with culturally diverse patients [41].

Patient Engagement and Activation #

Patient engagement represents a broader concept that combines patient activation with interventions designed to increase activation and promote positive patient behaviors [42]. Patient activation refers to a patient’s knowledge, skills, ability, and willingness to manage his or her own health and care [43]. Research consistently demonstrates that patients who are more activated experience better health outcomes and incur lower costs compared to less activated patients [44,45].

The Patient-Centered Outcomes Research Institute (PCORI) has been instrumental in advancing patient engagement in research, requiring investigators to engage patients and other healthcare stakeholders throughout the research process from topic selection through design, conduct, and dissemination of results [46,47]. Analysis of PCORI-funded projects reveals that patient engagement provides valuable contributions to research feasibility, acceptability, rigor, and relevance, with engaged patients and stakeholders contributing to study design, outcome selection, intervention tailoring, and participant enrollment [48].

A scoping review of patient engagement impact identified four key outcome categories: (1) health outcomes and effectiveness, including improved quality of care and patient satisfaction; (2) patient compliance with improved adherence to treatment processes; (3) self-efficacy with increased patient responsibility and motivation for health management; and (4) return on investment considerations including cost-effectiveness [49]. Evidence suggests that engaging patients helps reshape care and treatment in ways that fit their needs and preferences, ultimately resulting in improved outcomes [50].

Health Systems Science Integration #

The integration of patient-centered care within Health Systems Science represents a critical evolution in medical education and healthcare delivery [51,52]. HSS emerged to address competency gaps in healthcare professionals who must practice within increasingly complex, adaptive health systems characterized by fragmentation, growing health inequities, and multiple stakeholders [53]. The shift toward patient-centered care requires competencies including demonstrating cultural humility, taking holistic and systems-based approaches, and practicing effective communication and coordination [54].

Medical education initiatives incorporating HSS aim to develop “systems citizens”—physicians who understand they are part of complex adaptive systems and who strive to improve patient care and population health [55,56]. Value-added clinical systems learning roles in medical education have demonstrated that experiential opportunities focused on patient-centered care can enhance students’ understanding of patients’ perspectives on healthcare, barriers and social determinants of health, healthcare systems and delivery, interprofessional collaboration, and communication approaches [57,58].

Graduate medical education programs increasingly recognize that core domains encompassed by HSS—including patient safety, healthcare quality, care transitions, well-being, and professionalism—directly align with competencies needed to deliver patient-centered care [59]. The development of HSS distinction tracks and curricula aims to create physicians equipped with tools needed to achieve the quintuple aim of improved patient experience, better health outcomes, reduced costs, enhanced provider satisfaction, and health equity [60].

Implementation and Organizational Factors #

Successfully implementing patient-centered care requires organizational focus on leadership values, human resources policies that recruit and retain staff with aptitudes for service and empathy, and continuous measurement of patient experience using well-designed surveys and qualitative methods [61]. Healthcare organizations must actively understand what patients value through methods such as focus groups, interviews, and partnership with patients and families in co-designing care, educational materials, and communication resources [62].

Research on high-performing healthcare organizations reveals that tensions may arise when attempting to deliver both evidence-based practice and patient-centered care, but organizations that excel in both domains share unique characteristics including strong communication cultures, institutional prioritization of both domains in performance feedback, and dedicated cross-department organizing bodies for implementation work [63,64]. Best practices for facilitating patient-centered care and care coordination include institutional values surrounding PCC, optimization of information technology infrastructure to enhance performance and communication, appropriate pay structures and employee incentives, and dedicated implementation teams [65].

Major barriers to delivering patient-centered care identified in peer-reviewed literature include: (1) challenges in understanding patient context and collecting necessary information, (2) difficulties building trust and mutual respect between patients and providers, (3) misalignment of incentives with patient-centered care goals, and (4) lack of cultural change within medical practice to support PCC delivery [66]. Addressing these barriers requires multi-level interventions spanning individual provider training, care team development, organizational transformation, and health system redesign.

Outcomes and Evidence Base #

The evidence base supporting patient-centered care continues to grow, demonstrating associations with multiple positive outcomes across diverse clinical settings and patient populations [67]. Research indicates that PCC improves healthcare outcomes for chronic diseases including depression and anxiety disorders, cardiovascular disease, diabetes, and substance use disorders [68,69]. By improving health outcomes for inpatients and reducing physician-induced demand, PCC benefits both patients and health insurance systems [70].

Studies examining patient-centered care in hospital settings reveal that patients’ experiences of PCC are associated with greater satisfaction, reduced symptom burden, enhanced trust in the healthcare system, and perceptions of excellent and trustworthy care [71]. When care continuity, clear accountability, and caring attitudes are achieved across the care continuum, patients and caregivers feel supported rather than abandoned by the healthcare system [72].

The relationship between patient-centered care and health outcomes appears mediated through multiple mechanisms including improved patient engagement, enhanced therapeutic alliance, better treatment adherence, and more effective management of uncertainty [73,74]. Furthermore, patient-centered communication has been shown to increase patient satisfaction across multiple dimensions including relationships with physicians and other healthcare professionals, with stronger relationships when patients perceive higher levels of patient-centered behaviors [75].

Challenges and Future Directions #

Despite substantial progress in conceptualizing and promoting patient-centered care, significant challenges remain in translating principles into consistent practice [76]. Healthcare employees’ conceptualizations of PCC vary widely, with understanding ranging from focusing on patient perspectives and needs to more operational definitions involving specific processes and behaviors [77]. This variability in understanding can impede systematic implementation and evaluation of patient-centered care initiatives.

Future research must address several critical gaps including better understanding of how to measure patient-centered care comprehensively across all six IOM dimensions, developing validated patient-reported measures that capture the full spectrum of patient-centeredness, and identifying strategies for sustaining PCC implementation in resource-constrained environments [78,79]. Additionally, research is needed on the long-term impact of medical education initiatives incorporating patient-centered care principles on practicing physicians’ behaviors and patient outcomes [80].

The digital transformation of healthcare presents both opportunities and challenges for patient-centered care [81]. While technologies like patient portals, telemedicine, and electronic health records can enhance access and communication, they may also exacerbate disparities if not carefully designed with equity considerations, particularly for populations on the disadvantaged side of the digital divide [82]. Ensuring that technological innovations support rather than undermine patient-centered care will require thoughtful implementation with meaningful patient and community engagement.

Conclusion #

Patient-centered care represents a fundamental transformation in how healthcare is conceptualized and delivered, shifting from disease-focused, provider-driven models to approaches that honor patients as whole persons with unique values, preferences, needs, and goals. Within the framework of Health Systems Science, patient-centered care connects individual clinical encounters with broader systems-level concerns including quality improvement, population health, care coordination, and health equity. The growing evidence base demonstrates that patient-centered care improves patient satisfaction, health outcomes, and potentially healthcare costs, while presenting implementation challenges that require sustained attention to organizational culture, provider training, and system redesign. As healthcare continues to evolve toward greater complexity and integration, patient-centered care will remain essential for achieving high-quality, equitable healthcare that truly serves patients and populations.

References #

  1. Havana T, Kuha S, Ryhänen AM, et al. Patients’ experiences of patient‐centred care in hospital setting: A systematic review of qualitative studies. Scand J Caring Sci. 2023;37(3):626-644. https://doi.org/10.1111/scs.13174
  2. Langberg EM, Dyhr L, Davidsen AS. Defining and implementing patient-centered care: An umbrella review. Patient Educ Couns. 2022;105(7):1924-1937. https://doi.org/10.1016/j.pec.2021.12.018
  3. Yu C, Xian Y, Jing T, et al. More patient-centered care, better healthcare: the association between patient-centered care and healthcare outcomes in inpatients. Front Public Health. 2023;11:1148277. https://doi.org/10.3389/fpubh.2023.1148277
  4. Gonzalo JD, Ahluwalia A, Hamilton M, et al. Lessons learned from implementing health systems science and community service course for fourth-year medical students. BMC Med Educ. 2025;25:369. https://doi.org/10.1186/s12909-025-07137-3
  5. Gonzalo JD, Wolpaw D, Graaf D, Thompson BM. Educating patient-centered, systems-aware physicians: a qualitative analysis of medical student perceptions of value-added clinical systems learning roles. BMC Med Educ. 2018;18:248. https://doi.org/10.1186/s12909-018-1345-5
  6. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001.
  7. Luxford K, Safran DG, Delbanco T. Promoting patient-centered care: a qualitative study of facilitators and barriers in healthcare organizations with a reputation for improving the patient experience. Int J Qual Health Care. 2011;23(5):510-515. https://doi.org/10.1093/intqhc/mzr024
  8. Davis K, Schoenbaum SC, Audet AM. A 2020 vision of patient-centered primary care. J Gen Intern Med. 2005;20(10):953-957. https://doi.org/10.1111/j.1525-1497.2005.0178.x
  9. Tzelepis F, Sanson-Fisher RW, Zucca AC, Fradgley EA. Measuring the quality of patient-centered care: why patient-reported measures are critical to reliable assessment. Patient Prefer Adherence. 2015;9:831-835. https://doi.org/10.2147/PPA.S81975
  10. Gerteis M, Edgman-Levitan S, Daley J, Delbanco TL. Through the Patient’s Eyes: Understanding and Promoting Patient-Centered Care. San Francisco, CA: Jossey-Bass; 1993.
  11. Langberg EM, Dyhr L, Davidsen AS. Development of the concept of patient-centredness – A systematic review. Patient Educ Couns. 2019;102(7):1228-1236. https://doi.org/10.1016/j.pec.2019.02.023
  12. Fix GM, Hogan TP, Amante DJ, et al. Patient‐centred care is a way of doing things: How healthcare employees conceptualize patient‐centred care. Health Expect. 2018;21(1):300-307. https://doi.org/10.1111/hex.12615
  13. Mead N, Bower P. Patient-centeredness: a conceptual framework and review of the empirical literature. Soc Sci Med. 2000;51(7):1087-1110. https://doi.org/10.1016/s0277-9536(00)00098-8
  14. Mead N, Bower P. Measuring patient-centredness: a comparison of three observation-based instruments. Patient Educ Couns. 2000;39(1):71-80. https://doi.org/10.1016/s0738-3991(99)00092-0
  15. Stiggelbout AM, Van der Weijden T, De Wit MP, et al. Shared decision making: really putting patients at the centre of healthcare. BMJ. 2012;344:e256. https://doi.org/10.1136/bmj.e256
  16. Elwyn G, Frosch D, Thomson R, et al. Shared decision making: a model for clinical practice. J Gen Intern Med. 2012;27(10):1361-1367. https://doi.org/10.1007/s11606-012-2077-6
  17. Barry MJ, Edgman-Levitan S. Shared decision making—pinnacle of patient-centered care. N Engl J Med. 2012;366(9):780-781. https://doi.org/10.1056/NEJMp1109283
  18. Montori VM, Kunneman M, Brito JP. Shared decision-making as a method of care. BMJ Evid Based Med. 2023;28(4):213-217. https://doi.org/10.1136/bmjebm-2022-112068
  19. Hargraves I, LeBlanc A, Shah ND, Montori VM. Shared decision making: the need for patient-clinician conversation, not just information. Health Aff (Millwood). 2016;35(4):627-629. https://doi.org/10.1377/hlthaff.2015.1354
  20. Stacey D, Légaré F, Lewis K, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2017;4(4):CD001431. https://doi.org/10.1002/14651858.CD001431.pub5
  21. Spronk I, Meijers MC, Heins MJ, et al. Shared decision making, patient-centered communication and patient satisfaction – A cross-sectional analysis. Patient Educ Couns. 2022;105(7):2139-2144. https://doi.org/10.1016/j.pec.2022.03.006
  22. Lin SY, Lewis HE. Shared decision making and its role in end of life care. J Palliat Med. 2015;18(10):862-864. https://doi.org/10.1089/jpm.2015.0209
  23. Patel S, Ngunjiri A. Shared decision-making in patient care: Advantages, barriers and potential solutions. J Brown Hosp Med. 2024;2(3):16-20. https://doi.org/10.56305/001c.122787
  24. Lamiani G, Barello S, Browning DM, et al. A literature-based study of patient-centered care and communication in nurse-patient interactions: barriers, facilitators, and the way forward. BMC Nurs. 2021;20(1):158. https://doi.org/10.1186/s12912-021-00684-2
  25. Aung L, Saw YM, Saw TN, et al. Quality communication can improve patient-centred health outcomes among older patients: a rapid review. BMC Health Serv Res. 2023;23(1):897. https://doi.org/10.1186/s12913-023-09869-8
  26. Epstein RM, Street RL Jr. The values and value of patient-centered care. Ann Fam Med. 2011;9(2):100-103. https://doi.org/10.1370/afm.1239
  27. Stewart M, Brown JB, Donner A, et al. The impact of patient-centered care on outcomes. J Fam Pract. 2000;49(9):796-804.
  28. King A, Hoppe RB. “Best practice” for patient-centered communication: a narrative review. J Grad Med Educ. 2013;5(3):385-393. https://doi.org/10.4300/JGME-D-13-00072.1
  29. Roter DL, Stewart M, Putnam SM, et al. Communication patterns of primary care physicians. JAMA. 1997;277(4):350-356. https://doi.org/10.1001/jama.1997.03540280088045
  30. Lambert MJ, Barley DE. Research summary on the therapeutic relationship and psychotherapy outcome. Psychotherapy. 2001;38(4):357-361. https://doi.org/10.1037/0033-3204.38.4.357
  31. Çakmak C, Uğurluoğlu Ö. The effects of patient-centered communication on patient engagement, health-related quality of life, service quality perception and patient satisfaction in patients with cancer: A cross-sectional study in Türkiye. Asia Pac J Oncol Nurs. 2024;11(3):100376. https://doi.org/10.1016/j.apjon.2024.100376
  32. Street RL Jr, Makoul G, Arora NK, Epstein RM. How does communication heal? Pathways linking clinician-patient communication to health outcomes. Patient Educ Couns. 2009;74(3):295-301. https://doi.org/10.1016/j.pec.2008.11.015
  33. Beach MC, Price EG, Gary TL, et al. Cultural competence: a systematic review of health care provider educational interventions. Med Care. 2005;43(4):356-373. https://doi.org/10.1097/01.mlr.0000156861.58905.96
  34. Betancourt JR, Green AR, Carrillo JE, Ananeh-Firempong O 2nd. Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Rep. 2003;118(4):293-302. https://doi.org/10.1016/S0033-3549(04)50253-4
  35. Office of Minority Health. National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care. Washington, DC: U.S. Department of Health and Human Services; 2013.
  36. Beach MC, Saha S, Cooper LA. The role and relationship of cultural competence and patient-centeredness in health care quality. Commonwealth Fund. 2006;960:1-26.
  37. Saha S, Beach MC, Cooper LA. Patient centeredness, cultural competence and healthcare quality. J Natl Med Assoc. 2008;100(11):1275-1285. https://doi.org/10.1016/s0027-9684(15)31505-4
  38. Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academies Press; 2003.
  39. Cooper LA, Roter DL, Carson KA, et al. Practicing cultural competence and cultural humility in the care of diverse patients. Focus (Am Psychiatr Publ). 2020;18(1):49-51. https://doi.org/10.1176/appi.focus.20190041
  40. Tervalon M, Murray-García J. Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. J Health Care Poor Underserved. 1998;9(2):117-125. https://doi.org/10.1353/hpu.2010.0233
  41. Foronda C, Baptiste DL, Reinholdt MM, Ousman K. Rethinking cultural competence: Shifting to cultural humility. Public Health Nurs. 2021;38(1):78-86. https://doi.org/10.1111/phn.12796
  42. Carman KL, Dardess P, Maurer M, et al. Patient and family engagement: a framework for understanding the elements and developing interventions and policies. Health Aff (Millwood). 2013;32(2):223-231. https://doi.org/10.1377/hlthaff.2012.1133
  43. Hibbard JH, Stockard J, Mahoney ER, Tusler M. Development of the Patient Activation Measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Serv Res. 2004;39(4 Pt 1):1005-1026. https://doi.org/10.1111/j.1475-6773.2004.00269.x
  44. Hibbard JH, Greene J. What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs. Health Aff (Millwood). 2013;32(2):207-214. https://doi.org/10.1377/hlthaff.2012.1061
  45. Greene J, Hibbard JH. Why does patient activation matter? An examination of the relationships between patient activation and health-related outcomes. J Gen Intern Med. 2012;27(5):520-526. https://doi.org/10.1007/s11606-011-1931-2
  46. Frank L, Forsythe L, Ellis L, et al. Conceptual and practical foundations of patient engagement in research at the patient-centered outcomes research institute. Qual Life Res. 2015;24(5):1033-1041. https://doi.org/10.1007/s11136-014-0893-3
  47. Forsythe LP, Carman KL, Szydlowski V, et al. Patient engagement in research: Early findings from the Patient-Centered Outcomes Research Institute. Health Aff (Millwood). 2019;38(3):359-367. https://doi.org/10.1377/hlthaff.2018.05067
  48. Mullins CD, Abdulhalim AM, Lavallee DC. Continuous patient engagement in comparative effectiveness research. JAMA. 2012;307(15):1587-1588. https://doi.org/10.1001/jama.2012.442
  49. Shayan SJ, Kiwanuka F, Nakaye Z. Impact of patient engagement on healthcare quality: A scoping review. J Patient Exp. 2022;9:23743735221125439. https://doi.org/10.1177/23743735221125439
  50. Clavel N, Paquette J, Dumez V, et al. Patient engagement in care: a scoping review of recently validated tools assessing patients’ and healthcare professionals’ preferences and experience. Health Expect. 2021;24(6):1924-1935. https://doi.org/10.1111/hex.13344
  51. Skochelak SE, Hammoud MM, Lomis KD, et al. Health Systems Science. 2nd ed. Philadelphia, PA: Elsevier; 2020.
  52. Gonzalo JD, Haidet P, Papp KK, et al. Educating for the 21st-century health care system: an interdependent framework of basic, clinical, and systems sciences. Acad Med. 2017;92(1):35-39. https://doi.org/10.1097/ACM.0000000000000951
  53. Lucey CR. Medical education: part of the problem and part of the solution. JAMA Intern Med. 2013;173(17):1639-1643. https://doi.org/10.1001/jamainternmed.2013.9074
  54. Gonzalo JD, Ahluwalia A, Hamilton M, et al. Health systems science integration: a necessary evolution in medical education. Acad Med. 2023;98(11S):S1-S10. https://doi.org/10.1097/ACM.0000000000005426
  55. Gonzalo JD, Dekhtyar M, Starr SR, et al. Health systems science curricula in undergraduate medical education: identifying and defining a potential curricular framework. Acad Med. 2017;92(1):123-131. https://doi.org/10.1097/ACM.0000000000001177
  56. Borkan JM, George P, Tunkel AR. Integrated Learning and Health Systems Science within Medical Education: Recent Advances. Med Teach. 2018;40(8):775-783. https://doi.org/10.1080/0142159X.2018.1481285
  57. Gonzalo JD, Wolpaw D, Graaf D, Thompson BM. Educating patient-centered, systems-aware physicians: a qualitative analysis of medical student perceptions of value-added clinical systems learning roles. BMC Med Educ. 2018;18:248. https://doi.org/10.1186/s12909-018-1345-5
  58. Lin SY, Schillinger E, Irby DM. Value-added medical education: engaging future doctors to transform health care delivery today. J Gen Intern Med. 2015;30(2):150-151. https://doi.org/10.1007/s11606-014-3018-3
  59. Pandya DS, Ferris DG, Salas RME, Bhavsar AP. Health systems science integration in graduate medical education: A pathway to quintuple aim success for independent practice. Am J Med. 2024;137(9):819-827. https://doi.org/10.1016/j.amjmed.2024.04.016
  60. Bodenheimer T, Sinsky C. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med. 2014;12(6):573-576. https://doi.org/10.1370/afm.1713
  61. Schlesinger M. The patient as consumer in healthcare: how well does the notion work? Health Aff (Millwood). 2020;39(3):359-367. https://doi.org/10.1377/hlthaff.2020.00041
  62. Luxford K. Patient-centered care: achieving higher quality by designing care through the patient’s eyes. Isr J Health Policy Res. 2021;10(1):21. https://doi.org/10.1186/s13584-021-00459-9
  63. Rahn NL, George JA, Kutney-Lee A. Evidence-based practice and patient-centered care: Doing both well. Health Care Manage Rev. 2021;46(3):174-184. https://doi.org/10.1097/HMR.0000000000000254
  64. Aboumatar H, Nunes K, Srivastava A, et al. How health systems facilitate patient-centered care and care coordination: a case series analysis to identify best practices. BMC Health Serv Res. 2022;22(1):1448. https://doi.org/10.1186/s12913-022-08623-w
  65. Aboumatar HJ, Chang BH, Al Danaf J, et al. Promising practices for achieving patient-centered hospital care: a national study of high-performing US hospitals. Med Care. 2015;53(9):758-767. https://doi.org/10.1097/MLR.0000000000000396
  66. AcademyHealth. Delivery of Patient Centered Care in the U.S. Health Care System. Washington, DC: Robert Wood Johnson Foundation; 2019.
  67. Anhang Price R, Elliott MN, Zaslavsky AM, et al. Examining the role of patient experience surveys in measuring health care quality. Med Care Res Rev. 2014;71(5):522-554. https://doi.org/10.1177/1077558714541480
  68. Robinson JH, Callister LC, Berry JA, Dearing KA. Patient-centered care and adherence: Definitions and applications to improve outcomes. J Am Acad Nurse Pract. 2008;20(12):600-607. https://doi.org/10.1111/j.1745-7599.2008.00360.x
  69. Dwamena F, Holmes-Rovner M, Gaulden CM, et al. Interventions for providers to promote a patient-centred approach in clinical consultations. Cochrane Database Syst Rev. 2012;12:CD003267. https://doi.org/10.1002/14651858.CD003267.pub2
  70. Yu C, Xian Y, Jing T, et al. More patient-centered care, better healthcare: the association between patient-centered care and healthcare outcomes in inpatients. Front Public Health. 2023;11:1148277. https://doi.org/10.3389/fpubh.2023.1148277
  71. Doyle C, Lennox L, Bell D. A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open. 2013;3(1):e001570. https://doi.org/10.1136/bmjopen-2012-001570
  72. Wolff JL, Berger A, Clarke D, et al. Patients, care partners, and shared access to the patient portal: online practices at an integrated health system. J Am Med Inform Assoc. 2016;23(6):1150-1158. https://doi.org/10.1093/jamia/ocw025
  73. Ekman I, Swedberg K, Taft C, et al. Person-centered care—ready for prime time. Eur J Cardiovasc Nurs. 2011;10(4):248-251. https://doi.org/10.1016/j.ejcnurse.2011.06.008
  74. Safran DG, Miller W, Beckman H. Organizational dimensions of relationship-centered care. J Gen Intern Med. 2006;21 Suppl 1:S9-S15. https://doi.org/10.1111/j.1525-1497.2006.00303.x
  75. Çakmak C, Uğurluoğlu Ö. The effects of patient-centered communication on patient engagement, health-related quality of life, service quality perception and patient satisfaction in patients with cancer: A cross-sectional study in Türkiye. Asia Pac J Oncol Nurs. 2024;11(3):100376. https://doi.org/10.1016/j.apjon.2024.100376
  76. Meterko M, Wright S, Lin H, et al. Mortality among patients with acute myocardial infarction: the influences of patient-centered care and evidence-based medicine. Health Serv Res. 2010;45(5 Pt 1):1188-1204. https://doi.org/10.1111/j.1475-6773.2010.01138.x
  77. Fix GM, Hogan TP, Amante DJ, et al. Patient‐centred care is a way of doing things: How healthcare employees conceptualize patient‐centred care. Health Expect. 2018;21(1):300-307. https://doi.org/10.1111/hex.12615
  78. Scholl I, Zill JM, Härter M, Dirmaier J. An integrative model of patient-centeredness – a systematic review and concept analysis. PLoS One. 2014;9(9):e107828. https://doi.org/10.1371/journal.pone.0107828
  79. Epstein RM, Fiscella K, Lesser CS, Stange KC. Why the nation needs a policy push on patient-centered health care. Health Aff (Millwood). 2010;29(8):1489-1495. https://doi.org/10.1377/hlthaff.2009.0888
  80. Gonzalo JD, Ahluwalia A, Hamilton M, et al. Lessons learned from implementing health systems science and community service course for fourth-year medical students. BMC Med Educ. 2025;25:369. https://doi.org/10.1186/s12909-025-07137-3
  81. Hurst EJ. Evolutions in telemedicine: from smoke signals to mobile health solutions. J Hosp Librariansh. 2016;16(2):174-185. https://doi.org/10.1080/15323269.2016.1150750
  82. Beach MC, Saha S, Cooper LA. The role and relationship of cultural competence and patient-centeredness in health care quality. Commonwealth Fund. 2006;960:1-26.
Updated on December 11, 2025