Patient Engagement in Design,
Delivery, & Discovery
8th Annual
Utah Health Services Research Conference
February 25, 2013
Lucy A. Savitz, Ph.D., MBA
Director, Research and Education
Institute for Healthcare Delivery Research
Intermountain Healthcare
Research Professor, Epidemiology Division, Internal Medicine
Director, Community Engagement Core, CCTS
University of Utah
The
‘blockbuster
drug of the
century’
revealed in this
issue!
Susan Dentzer,, Editor-in-Chief, Health Affairs, 32(2): 202.
The ‘drug’ is actually a concept…
The ‘drug’ is actually a concept…
Patient
activation &
engagement
Many ways to define the concept…
• Patient engagement: actions that people take
for their health and to benefit from care (IHI)
• Patient activation: understanding one’s own
role in the care process and having the
knowledge, skills, and confidence to take on
that role (Hibbard et al.)
Shared Decision Making
• Intended to improve patient
knowledge & involvement in
decision-making to promote an
informed, value-based choice among
2 or more medically reasonable
alternatives (O’Connor et al.)
Patient Engagement in
Knowledge & Involvement about Care
Shared
Patient
Decision
Activation
Making
|______________________________|
Savitz, LA
Holistic View of Patient Engagement
• More holistic definitions broaden the concept
further to encompass care delivery, design &
research/discovery
• Patients as partners
– Personal responsibility & self-management
– Quality improvement
• (< 1/3 patients involved patient-centered medical home QI)
– Care design
• (e.g., mobile apps)
– Governance
Carman, Dardess, Maurer, Sofaer, Adams, Bechtel, Sweeney, page 225
CMMI & Hospital Engagement
Network Assessment of Engagement
1.
2.
3.
4.
5.
Prior to admission, hospital staff provides and discusses a
discharge planning checklist with every patient that has a
scheduled admission, allowing questions or comments from the
patient or family.
Hospitals conduct both shift change huddles for staff & do bedside
reporting with patients & family members in all feasible cases.
Hospital has a dedicated person or functional area that is
proactively responsible for Patient and Family Engagement and
systematically evaluates engagement activities.
Hospital has an active Patient and Family Engagement Committee
OR at least one former patient that serves on a patient safety or
quality improvement committee or team.
Hospital has one or more patient(s) who serve on a Governing
and/or Leadership Board serving as a patient representative.
Provisional Results,
Intermountain-led HEN 2-13
Patient Engagement Criteria Met
35%
31%
30%
27%
25%
23%
20%
15%
13%
10%
6%
5%
0%
0%
0
1
2
3
4
5
Patient engagement is one strategy to
achieve the "triple aim”
• A growing body of evidence demonstrates
that patients who are more actively involved
in their health care experience
– better health outcomes
– Improved satisfaction
– lower cost
What Will It Take to Move from Here to
There: Design, Delivery, or Discovery
• Need for training
– Physicians
– Clinical and non-clinical staff
– Patients, families, caregivers
• It takes a team-based approach
• Culture change
– Common language
– Viewing patients/caregivers as partners
• Evidence that engagement makes a difference
Some HSR Challenges
• Engagement as a new approach to research
• Limited/lacking tools to capture engagement
• More research needed to understand:
– How engagement leads to improved outcomes
– Where engagement is best placed (setting, timing)
– What should be offered
• nudging vs. balanced, nondirective decision aids
– Ways to engage all patients (literacy)
– Ethical implications of engagement
• abandonment or penalties for non-adherent patients
Patient Centered Outcomes Research
Institute (PCORI)
• www.pcori.org
• ACA mandates that PCORI seek
meaningful ways to integrate the
patient’s voice into the research
process
–
–
–
–
Generate topics for research
Help to prioritize topics
Select topics for funding
Ensure patient involvement in design
Local Resources
• Community Engagement Core of the Center
for Clinical and Translation Services (CCTS)
• Patient Centered Outcomes /Comparative
Effectiveness Research Certificate Program
• Patient Centered Outcomes Research Class,
University of Utah School of Medicine, offered
First Summer Session Annually