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In an effort to tailor treatment options to the patient’s needs and improve quality of care, a pair of faculty leaders from the UC Irvine School of Pharmacy & Pharmaceutical Sciences developed a patient-centered framework to advance personalized medicine.
The four-step model can be more easily implemented in an outpatient clinic for chronic disease treatment, but components could also be applied to inpatient settings.
The research team developing the framework included Associate Dean of Assessment and Quality Jonathan Watanabe, PharmD, PhD, Founding Dean Jan Hirsch, BSPharm, PhD, and UCLA David Geffen School of Medicine Professor Derjung Tarn, MD, PhD.
“This framework entails a systematic, repeatable approach for including patient preferences and characteristics,” Watanabe said, “as well as population-based value evidence (clinical, economic and humanistic), to bolster shared decision-making based on relevant data and individualized goals to optimize therapy and ultimately meaningful health outcomes.”
The goal of patient-centered care is to empower patients to be informed decision makers by providing whole-person care that is both compassionate and empathetic. In order to improve healthcare quality indicators in the United States, the research team stated that two activities must occur:
- Incorporate patient preferences in treatment considerations
- Apply population-based value assessments in formation of the patient care plan
To achieve these goals, Watanabe, Hirsch and Tarn propose a framework that centers on patient values and shared decision making that is continuously refined by utilizing a population-based evidence assessment repository (PEAR).
Working through the PEAR system, the clinician would focus on four steps:
- Elicitation and Contribution: Involves the patient summarizing their reason for the visit to the extent possible and provides fields for the patient to “contribute” key information on their preferences, as well as social determinants, that may influence the outcomes and affect relevance of potential treatment options.
- Goal Orientation and Harmonization: Involves the intentional process of determining the patient’s goals of treatment via discussion with the clinician to map to the patient-centered outcomes that are salient (“orientation”). This step fosters the shared decision making needed to finalize the goals of the current care plan (“harmonization”).
- Treatment Plan Formation: To reduce uncertainty about choosing the right medications, the evidence repository would display options with the probability of success, based on the patient-centered outcomes goals that were formed in Step 2 that incorporate patient preferences and characteristics developed in Step 1.
- Monitoring and Optimization: Many patients require more than one medication to achieve chronic disease control with the doses adjusted to achieve maximum efficacy. “Monitoring” involves deliberate planning for follow-up and “optimization” is informed by the evidence assessment repository on data-drive steps to adjust the treatment.
“Beyond optimizing medication regimens at the patient level,” Hirsch said, “an important function of the PEAR is the ability to capture the patient-level evidence-driven decisions and resulting outcomes in a registry to continually improve the real-world population based comparative value evidence for future patients.”
Dr. Tarn added: “As a physician, I believe this framework proposed in this study is an important step toward incorporating patient voices when developing individualized treatment.”
To view the four-step framework in more detail, you can access the complete paper.
The paper, titled Evolution of Precision Medicine: Applying a Population-Based Evidence Assessment Repository to Achieve Patient-Centered Outcomes at the Point of Care, was published in a supplement to the International Society for Pharmacoenomics and Outcomes Research’s news magazine, Value & Outcomes Spotlight.
In December 2020, this research proposal from Watanabe, Hirsch and Tarn received a Value Assessment Challenge Award from the PhRMA Foundation.