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

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Published: Feb 2, 2017
DOI: https://doi.org/10.5750/ijpcm.v6i4.610
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

Main Article Content

Juan E Mezzich
Mount Sinai School of Medicine, New York University
Levent Kirisci
Professor of Statistics in Pharmaceutical Sciences, University of Pittsburgh, Pittsburgh, PA USA; Statistical Editor, International Journal of Person Centered Medicine.
Ihsan Salloum
Professor of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, FLA, USA; Chair, Section on Classification and Diagnostic Evaluation, World Psychiatric Association.
Jitendra Trivedi
Professor, Department of Psychiatry, King George’s Medical University, Lucknow, Uttar Pradesh, India (deceased).
Sujit Kumar Kar
Assistant Professor, Department of Psychiatry, King George’s Medical University, Lucknow, Uttar Pradesh, India.
Neal Adams
Deputy Director, California Institute for Mental Health, Berkeley, California, USA.
Janet Wallcraft
Research Fellow, University of Birmingham, Birmingham, United kingdom.

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.

Article Details

Issue
Vol. 6 No. 4 (2016)
Section
Regular Articles
Author Biography

Juan E Mezzich, Mount Sinai School of Medicine, New York University

Born in Lima, Peru, of Yugoslavian and Peruvian ancestries. Medical graduate of Cayetano Heredia Peruvian University and president of the University Student Association.Psychiatric residency training, M.Sc. in Academic Psychiatry, and M.A. and Ph.D. in Mathematical and Statistical Psychology, all at Ohio State University, and diplomate of the American Board of Psychiatry and Neurology.Professorial positions in psychiatry, sequentially at Stanford University, California, the University of Pittsburgh, Pennsylvania, and the Mount Sinai School of Medicine, New York University.Doctor Honoris Causa at Athens University (Greece), Cordoba University (Argentina), Cayetano Heredia Peruvian University (Peru), and Cluj-Napoca University, Timisoara University and Oradea University (Romania). Honorary Professorships at Cayetano Heredia Peruvian University and University of Belgrade (Serbia), World Psychiatric Association Honorary Fellow, Simon Bolivar Award of the American Psychiatric Association, Past-President of the American Society of Hispanic Psychiatry, honorary member/fellow of several national psychiatric associations, and visiting professor and lecturer at academic institutions over 80 countries across all continents.Earlier academic and international work: Secretary & Chair (1983-1996) and Honorary Chair (2008-) of the WPA Section on Classification and Diagnostic Assessment; member of the ICD-10 Work Group and the DSM-IV Task Force; chair of the US National Institute of Mental Health Group on Culture, Diagnosis and Care; consultant on the development of the Chinese Classification of Mental Disorders (3rd Ed.), the Japanese Modification of ICD-10, the Third Cuban Glossary of Psychiatry, and the Latin American Guide for Psychiatric Diagnosis (GLADP); and director of the 1993-2003 WPA International Guidelines for Diagnostic Assessment (IGDA).Author/coauthor of over 280 scientific journal articles and book chapters (including sections on diagnosis,   epidemiology, and culture in Kaplan & Sadock's and Tasman et al’s Textbooks of Psychiatry), and of 26 books and monographs, including Images of Latin American Psychiatry (2013), Coercive Treatment in Psychiatry (2011), Conceptual Bases of Psychiatry for the Person (2011), Conceptual Explorations on Person-centered Medicine (2010), Psychiatric Diagnosis: Challenges and Prospects (2009), Cultural Formulation: A Reader for Psychiatric Diagnosis (2008), Psychiatry and Sexual Health: An Integrative Approach (2006), Philosophical & Methodological Bases of Psychiatric Diagnosis (2005), Guía Latinoamericana de Diagnóstico Psiquiátrico (GLADP) (APAL, 2004), WPA International Guidelines for Diagnostic Assessment (IGDA) (2003), Cultural Psychiatry: International Perspectives (2001), Culture and Psychiatric Diagnosis: A DSM-IV Perspective (1996), Psychiatric Epidemiology (1994). Editor, Psychopathology, (2002-2010), Deputy Editor-in-Chief (2010-2011) and Editor in Chief (2013-  ), Int’l J Person Centered Medicine,  and editorial board member of 15 other medical journals in the Americas, Europe, Asia, and Africa.WPA Secretary General (1996-2002), Vice-President and President-Elect (2002-2005), President (2005-2008), and Council Member (2008- ). President (2009-2013) and then Secetary General (2013- ) of the International Network , now International College, of Person-centered Medicine.Current Work: 1) Person-centered Psychiatry and Medicine: Organization of the 2008, 2009, 2010 and 2011 Geneva Conferences on Person-centered Medicine, and Conferences in London (2007), Paris (2008), and Uppsala (2008) on Psychiatry for the Person; thematic publication of several monographs and journal editorials & papers, and initiating the International Network for Person-centered Medicine in collaboration with the World Medical Association, the World Health Organization and 25 other international medical and health bodies, 2) International diagnostic systems, particularly ICD-11, Person-centered Integrative Diagnosis, and Latin American Guide for Psychiatric Diagnosis, through monographs, journal papers, and conferences, 3) Culture-informed clinical concepts and procedures, including the Cultural Formulation, the Personal Health Scale, the Multi-ethnic Bicultural Scale, and the Multicultural Quality of Life Index through publications, conferences and research projects.

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