Patient Activation & Engagement
Basics
Institute For Clinical Systems Improvement
Beth Webb, Project Manager, RN, BA
May 29, 2013
Objectives
• Identify the vital role that patients and families
play in ensuring health and well-being as well as
facilitating better health outcomes
•Define the difference between patient
activation & patient engagement
•Identify three patient engagement strategies
and tools
© ICSI 2013
2
Patient and family centered care
• A partnership among practitioners, patients,
and their families (when appropriate) to
ensure that decisions respect patients’ wants,
needs, and preferences and that patients have
the education and support they need to make
decisions and participate in their own care
© ICSI 2013
3
Patient-Centered Means….
•
•
•
•
Respect and dignity
Information sharing
Participation
Collaboration
~Institute for Patient and Family Centered Care
www.ipffc.org
© ICSI 2013
4
Patient-Centered Means….
• Start where the patient is
• Encourage realistic steps– creating
opportunities to experience success
• Build on strengths
• Use measurement to assess and to track
progress
© ICSI 2013
5
Why be Patient-Centered?
•Total cost of care for patients with patient
centered care is 48.63% less than those without1
•Patient satisfaction can increase 3% or more when
patient centered care is introduced2
•70% of one MN health plan’s insured is getting
treatment from a provider under a TCOC
agreement
1Bertakis,
K, Azari, R, Patient Centered care is Associated with Decreased Health Care
Utilization, JABFM 24(3):229-239 (2011)
2 Charmel, P, Frampton, S, Building the business case for patient-centered care,
Healthcare Financial Management, March 2008
© ICSI 2013
6
Two Experts in the Room
Provider’s Expertise1
Patient’s Expertise
Diagnosis
Experience of illness
Disease Etiology
Social circumstances
Prognosis
Attitude to risk
Treatment options
Values
Outcome possibilities
Preferences
Coulter, A., Collins, A., Making Shared Decision-Making a Reality, The Kings Fund 2011
© ICSI 2013
7
Patient Activation
• Patient activation—an “individual’s”
knowledge, skill, and confidence for managing
his/her own health and health care
© ICSI 2013
8
Importance of Activation
• If people don’t understand their role, they
aren‘t going to take action, they aren’t going
to look for or take in new information
• If people don’t feel confident, they are less
likely to be pro-active
• This appears to be true regardless of condition
© ICSI 2013
9
Value of Activation
Research consistently finds that those who are
more activated are:
– Engaged in more preventive behaviors
– Engaged in more healthy behaviors
– Engaged in more disease specific selfmanagement behaviors
– Engaged in more health information seeking
behaviors
© ICSI 2013
10
Value of Knowing Activation Level
 To know who needs more support
 To target the types of support and information
patients and consumers need
 To evaluate efforts to increase activation
 To evaluate the quality of care
 To build the evidence base
© ICSI 2013
11
Activation is developmental
Source: J.Hibbard, University of Oregon
© ICSI 2013
12
Levels of Participation
•
International Association of Public Participation
© ICSI 2013
13
New Insights
• Can identify “next steps” more appropriately
• Presently asking too much of too many
• When we focus on the more complex and
difficult behaviors– we discourage the least
activated
• Start with patient’s values—minimize number
of requests
© ICSI 2013
14
Increasing Activation
• Tailored coaching
• Including brief coaching in the clinical
setting– with follow-up
• Segmentation approaches and differential
allocation of resources
• Care transitions and reducing hospital readmissions
© ICSI 2013
15
Patient and family engagement
• Patients, families, their representatives, and
health professionals working in active
partnership at various levels across the health
care system—direct care, organizational
design and governance, and policy making—to
improve health and health care.1
1Health
Aff February 2013 vol. 32 no. 2 223-231
© ICSI 2013
16
Tools for Partnering with Patients,
families and caregivers
• Understanding Behavior Change
– Stages of Change (Prochaska)
•
•
•
•
•
Active Listening
Coaching
Motivational Interviewing
Teach back
Shared Decision Making
© ICSI 2013
17
© ICSI 2013
18
Questions ?
Upcoming RARE Events….
• Stay tuned for the next RARE
Conversation in June 2013!
Future webinars…
• To suggest future topics for this
series, Reducing Avoidable
Readmissions Effectively “RARE”
Networking Webinars, contact Kathy
Cummings, kcummings@icsi.org