Table 1.

Disease-Oriented Versus Individualized Patient-Centered Approaches

	Disease-oriented	Individualized patient-centered
Clinical Decision Making*	Focuses on prevention, diagnosis and treatment of individual disease processes.	Focuses on the priorities and preferences of individual patients.
Underlying conceptualization of disease*	Disease results from an underlying pathophysiologic process.	Disease reflects the complex relationship between pathology, aging, social, psychological and other factors.
Treatment*	Targets underlying pathophysiologic mechanisms causing the disease process.	Targets modifiable factors impacting outcomes that matter to the patient, whether or not these are related one or more underlying disease processes.
Approach to symptoms*	Symptoms related to the disease-process are best treated by interventions targeted at the disease.	Symptoms can be a target for treatment even if they cannot be tied to a defined disease process.
Goals of treatment*	Clinical outcomes are those relevant to the underlying disease process. Survival is often considered to be the most important outcome.	Clinical outcomes are those that matter most to the patient and can be modified. In many instances, survival may be of less importance than other outcomes such as quality of life, functional status, pain control and independence.
Advantages	Provides a systematic framework for standardized evidence-based management of single disease processes. Is readily adapted to outcome assessment and performance measurement.	Embraces the possibility that older patients may have multiple different co-morbid conditions and that there is heterogeneity in health status, life expectancy, and treatment efficacy and patient preferences among older adults.
Disadvantages	Provides little guidance on how to negotiate the conflicting treatment priorities that arise in patients with multiple different co-morbid conditions, limited life expectancy, and distinct treatment preferences.	Clinicians may be inadequately prepared to identify patient preferences and goals and incorporate these into treatment strategies. There may be little evidence to support treatment decisions if outcomes that matter to the patient have not been studied. Does not lend itself to standardized practices, performance measurement and outcome assessment.

^*Adapted from Tinetti and Fried2 with permission of The Association of Professors of Medicine.