title: Circle of care modelling: an approach to assist in reasoning about healthcare change using a patient-centric system.
abstract: Many health system and health Information and Communication Technology (ICT) projects do not achieve their expected benefits. This paper presents an approach to exploring changes in the healthcare system to better understand the expected improvements and other changes by using a patient-centric modelling approach. Circle of care modeling (CCM) was designed to assist stakeholders in considering healthcare system changes using a patient centric approach.
  
  
  
  The CCM approach is described. It includes four steps, based on soft systems methodology: finding out, conceptual modelling, structured discussion, and describing potential improvements. There are four visualizations that are used though this process: patient-persona based rich pictures of care flows (as part of finding out), and three models: provider view, communication view, and information repository view (as part of conceptual modelling).
  
  
  
  Three case studies are presented where CCM was applied to different real-world healthcare problems: 1. Seeking improvements in continuity of care for end of life patients. 2. Exploring current practices for medication communication for ambulatory patients prior to an update of a jurisdictional drug information system. 3. Deciding how to improve attachment of patients to primary care. The cases illustrate how CCM helped stakeholders reason from a patient centered approach about gaps and improvements in care such as: data fragmentation (in 1), coordination efforts of medication management (in 2), and deciding to support a community health centre for unattached patients (in 3).
  
  
  
  The circle of care modelling approach has proved to be a useful tool in assisting stakeholders explore health system change in a patient centric approach. It is one way to instantiate the important principle of being patient centered into practice when considering health system changes.
authors.affiliation: Island Medical Program, University of British Columbia, Vancouver, Canada. morgan@leadlab.ca.|Department of Family Practice, Medical Science Building, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada. morgan@leadlab.ca.
authors.forename: Morgan
authors.identifier: 0000-0001-6409-1579
authors.initials: M
authors.lastname: Price
mesh_terms: D003142:Communication; D003151:Community Health Centers / Q000592:standards; D003266:Continuity of Patient Care / Q000592:standards; D003695:Delivery of Health Care / Q000592:standards*; D006801:Humans; D008490:Medical Informatics; D017146:Models, Organizational; D018802:Patient-Centered Care / Q000592:standards*; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards*; D058996:Quality Improvement
keywords: Circle of care; Clinical informatics; Modeling; Quality improvement