Model Overview

Centering is an evidence-based redesign of health care delivery that helps to promote:

safety,
efficiency,
effectiveness,
timeliness,
culturally appropriate patient-centered care, and
more equitable care.

Centering is a model of group healthcare, which incorporates three major components: assessment, education, and support. Group participants meet with their care provider and other group participants according to a regular schedule for a much longer period of time (usually 90-120 minutes) than a usual check-up visit. Centering promotes individual health empowerment and community-building. The 13 Essential Elements of Centering secure these benefits.

At the start of a typical session, patients have a brief individual assessment by the care provider, participate in self-care activities, complete a Self-Assessment Sheet on a particular topic, enjoy refreshments, and have informal conversation with the other participants. When the group “circles up” together, there is facilitated discussion about a heath topic and the exchange of corporate wisdom on shared health experiences. Groups are lively, interactive, and patient-centered.

There are patient materials available for three established areas of Centering care: CenteringPregnancy, CenteringParenting, and CenteringDiabetes. Centering Healthcare Institute (CHI) has also developed a line of group supplies and facilitator resources.

Agencies bill for group care in the same way as corresponding individual care visits. CenteringPregnancy care starts around the beginning of the second trimester and goes through delivery. CenteringParenting is pediatric care for newborns through their 1st birthday and beyond combined with well-woman care for the moms. The model for CenteringDiabetes is in its pilot testing and currently has 8 sessions for newly diagnosed patients.

Research has shown increased patient and provider satisfaction in Centering groups and improved patient outcomes.

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Institute of Medicine / Centering Table

TABLE: The Centering Model: Comparison to Rules for Health Care Redesign

From Rising S, Kennedy H, Klima C. (2004) Redesigning prenatal care through CenteringPregnancy. JMWH:49(5):398-404.

IOM’s Rules for Health Care Redesign	Essential Elements of Centering Programs	What Women have to say about CenteringPregnancy *
Care is based on continuous healing relationships.	Continuity and stability of group leadership Group composition is stable, but not rigid Facilitative leadership	“The other women in the group became another group of friends for me.” “I’d say the community building has been the most satisfying thing to see among patients and it has been the most satisfying thing for me, personally, because you become included in that community as well.”(provider)
Care is customized according to patient needs and values.	Each session has an overall plan; emphasis varies with group needs Facilitative leadership Opportunity for socialization is provided	“I’m learning that it doesn’t matter what the group doesn’t talk about because we’re talking about what matters to the group.”(provider) “I’m so happy to be here in this group. I feel so comfortable, and it feels so good that everyone here speaks Spanish. I have felt so alone in this country….” “I felt like I was in a family.” “We are all on the same path doing it together.”
The patient is the source of control.	Women are involved in self-care activities Facilitative leadership	“I really liked checking my blood pressure; it’s a great way of learning.” “They (providers) didn’t just give you medicine and not tell you what was wrong. Even if they tried to do that you had a chart there that told you what was wrong.”
Knowledge is shared and information flows freely.	Each session has an overall plan; emphasis varies with group needs Facilitative leadership Group is conducted in a circle	“You feel trust and you lose your embarrassment, because you speak your problems out loud and as they say, ‘a bunch of brains think better than one.” “The group helped us so much…others had the same concerns we had. Our discussions didn’t follow the agenda…we solved our own problems.”
Decision-making is evidence-based.	There is on-going evaluation of outcomes	“Centering will only move forward as a widely accepted model if empirical data document positive outcomes.” (administrator) “The women treasured what they learned, went home and taught their friends, and some now want to be nurses.”(provider)
Safety is a system property.	Women are involved in self-care activities Group is conducted in a circle Continuity and stability of group leadership Involvement of family support people is optional	“Although it was a group it seemed more intimate, more time was spent on specific issues that I’m not sure would have been brought up or discussed with a provider in a 10 minute session.” “In the group you have the same two people check you every time. You know your care is being watched.”
Transparency is necessary.	Women are involved in self-care activities There is on-going evaluation of outcomes Group is conducted in a circle	We watched each other grow; everybody loved it. ‘Oh, you’re a lot bigger this week!” “I liked how we were going through the same issues and discussed different methods or ways we approach them.”
Needs are anticipated.	Facilitative leadership Each session has an overall plan; emphasis varies with group needs	People would come to the group tired, anxious, worried and every single time, without fail, everyone left happy, laughing, lighter
Waste is continuously decreased.	Health assessment occurs within the group space Continuity and stability of group leadership	“We came at the same time and left at the same time and something was happening the whole time we were there.” “I enjoy the freedom, creativity, and common sense inherent in the Centering model of care. I feel like I’ve done meaningful and satisfying work after EVERY group, that maybe I’m participating in something with a lasting impact.”(provider)
Cooperation among clinicians is a priority.	Non-hierarchical cooperation occurs between different service providers	“We’re able to do some preventive medicine…it is impossible to present all of that content to women individually.”(physical therapist)