OCKHAM'S RAZOR, a line of reasoning that says the simplest answer is often correct, is attributed to the 14th-century Franciscan friar William of Ockham. A variation of Ockham's razor was used to synthesize the many reports of interventions for improving patients' outcomes of care. The result was the "Chronic Care Model" and within that model the "final common pathway" was the synergy between a prepared, activated patient and a proactive care team; a synergy many call engagement. (Bodenheimer et al., 2002; Dentzer, 2013). A useful, simple proxy for engagement is patient report of confidence to manage and control most health problems and risks (Wasson, 2013; Wasson & Coleman, 2014).
A practical simplification of Ockham applied to health care delivery in the early 21st century is illustrated in the Figure. It emphasizes health confidence as the easily measurable, patient-reported "final common pathway" for delivery design. Information quality is a critical catalyst for health confidence. A practice whose workforce is organized for the betterment of health confidence will have better outcomes than one that has, for example, easy access and efficiency but no such focus. Health confidence therefore rests on good information and a dedicated, behaviorally sophisticated workforce. Timely feedback available through modern personal technologies motivates change in behavior and supports the attainment of health confidence.
Six articles in this issue of the Journal of Ambulatory Care Management explore clinical practice processes and workers' roles that could strengthen engagement and health confidence. However, these interventions took place in a 20th-century culture of health delivery that has no simple, practical, measurable, and sharp Ockham point. No surprise that Vest and his colleagues find multiple practice patterns nested within the expansive notion of the Patient-Centered Medical Home. Or that, as 5 of the 6 articles point out, the health care workforce is locked into ways of doing business that are difficult to change.... any workforce will be constrained when it has to serve many masters and initiate jargon-laden, un-standardized, unnecessarily complex "Triple Aimed" "Engagement" strategies.
One can make the case that Ockham's razor will be unable to chop through the profligate incoherence of the United States health nonsystem. But I contend that health service researchers should do themselves and their patients a favor by using the razor to carefully dissect a pragmatic, unifying concept that links the evidence we know to what matters to patients and people. For want of a better alternative, the concept and measure for health confidence are available to us and can meet that need.
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