Developing a Measure of Person-Centered Care

Background and Purpose: Delivering person-centered care is a key component of health and mental health care reform. Agencies are therefore tasked with translating person-centered care for clinical utility and being able to document its practice. Moreover, agencies are increasingly asked to report outcome data, using quality improvement tools that are often limited in their ability to capture more nuanced, relational aspects of care. This study presents the validity and reliability of the Person-Centered Care Planning Assessment Measure (PCCP-AM), an objective quality improvement tool that measures the extent to which service planning is person-centered.

Methods: The 10-item PCCP-AM chart review instrument rates service plans on key domains of person-centered care: focusing on service user strengths, life goals, natural supports, self-directed actions and community integration. Item scores range from 1 to 4, with 3 and above indicating competency. As part of a larger randomized controlled trial, service plans completed by community mental health clinic providers were rated using the PCCP-AM. These service plans were sampled from across clinic programs including outpatient therapy, case management, and group homes. PCCP-AM scores of 2 raters for 62 service plans were compared to measure inter-rater reliability with a weighted Kappa analysis. PCCP-AM scores for 437 service plans were used to measure internal consistency with Cronbach’s alpha. PCCP-AM scores of 77 plans were correlated with independent expert ratings to establish validity.

Results: Weighted Kappas ranged from k = .324 to k = .681 (p = .001), indicating fair to substantial agreement between raters. Cronbach’s Alpha (α = .72), indicated acceptable reliability. Moderate correlation of total scores (r = .600, p = .010) supported PCCP-AM validity. Individual item scores supported the validity of items assessing service user input in care planning, life-oriented goals and objectives, planned use of natural supports and the broader community, and measurable objectives (r = .381 to r = .581, p = .010).

Conclusions and Implications: Findings demonstrate the PCCP-AM’s potential to be a valid and reliable objective measure of person-centered care. Although the results are promising, the measure needs more refinement to be a consistent and accurate tool to guide practice for clinicians and supervisors. By focusing service planning on service user life goals, strengths, natural supports and self-direction, the PCCP-AM can help clinicians improve their delivery of person-centered care and promote a more collaborative relationship between provider and service user. The PCCP-AM’s utility to agencies lies in its ability to provide objective measurement of a person-centered orientation that applies across program types, providing a tool to promote agency wide person-centered care, and further aiding supervisors who provide administrative and clinical supervision to service providers in varying programs.