Post on 25-May-2020
Patientengagementinprimarycare:Howfamilyphysicianscanpartnerwithpatients
AnjanaSharma,MDMASBeatriceHuang|MalO’Connor,Ph.D |RachelWillard-Grace,MPH| KevinGrumbach,MD
FamilyMedicineforAmerica’sHealth:PatientEngagementDayWebinarpresentation
April4,2019
Copyright2019,TheRegentsoftheUniversityofCaliforniaCreatedbyUCSFCenterforExcellenceinPrimaryCare.
AboutUs
AnjanaSharma,MDMASAssistantProfessorofFamily&CommunityMedicine
BeatriceHuangProjectManager,Analyst
Copyright2019,TheRegentsoftheUniversityofCaliforniaCreatedbyUCSFCenterforExcellenceinPrimaryCare.
PollQuestion#1– Aboutyou• Whatdisciplinesdowehaverepresentedonthecall?(selectallthatapply)
1. Qualityimprovementorpatientexperienceleads2. Nursing3. Primarycareclinicians(MD,DO,NP,PA)4. Patients/patientadvocates5. Clinicorhospitalmanagement
• Whatisyourpracticesetting?(Selectallthatapply)1. Soloorsmallprimarycarepractice2. Mediumsizepractice(5-10providers)3. Largepracticesetting4. Rural5. Suburban6. Urban7. Federallyqualifiedhealthcenterorsafety-netclinic8. Academicinstitution
Copyright2019,TheRegentsoftheUniversityofCaliforniaCreatedbyUCSFCenterforExcellenceinPrimaryCare.
Overview
• Whatispatientengagement?
• Evidencebaseforpatientengagement
• FamilyMedicineforAmerica’sHealthcasestudies
• Toolsforgettingstarted
Copyright2019,TheRegentsoftheUniversityofCaliforniaCreatedbyUCSFCenterforExcellenceinPrimaryCare.
Patientengagementisahot topic!
Copyright2019,TheRegentsoftheUniversityofCaliforniaCreatedbyUCSFCenterforExcellenceinPrimaryCare.
Whatispatientengagement?
Copyright2019,TheRegentsoftheUniversityofCaliforniaCreatedbyUCSFCenterforExcellenceinPrimaryCare.
Poll#2:Whatisyourdefinitionofpatientandfamilyengagement?1. Patientadherenceorcompliancewithmedicalcare2. Digitalportalsordigitalappstoimprovehealth3. Healthliteracy4. Patientfeedback,insurveysorinadvisorycouncils5. Communityinputintohealthcareneeds6. Patientadvocacyforhealthcarelawsandpolicies
Hint:allofthesearecorrect,butwhichisclosestforYOU?
Copyright2019,TheRegentsoftheUniversityofCaliforniaCreatedbyUCSFCenterforExcellenceinPrimaryCare.
Whatdoespatientengagementactuallymean?
“Patients,families,andcaregiversworkingwithhealthcarestaffin
partnershiptoimprovehealthcare”
LEVELOFPATIENTENGAGEMENT
PATIENTENGAGEMENTACTIVITIES
CASEEXAMPLE
INDIVIDUALShareddecision-making,motivationalinterviewing,healthcoaching,self-managementtools
Apatientlogsontotheirelectronicmedicalrecordandrecordstheirownbloodpressure
ORGANIZATIONALLEVEL(clinic,hospitalorsystem-level)
Patientexperiencesurveys,suggestionboxes,town-hallmeetings,patientadvisorycouncils,patientsworkingonqualityimprovementorsafetycommittees
Apatientadvisorycouncildevelopsanewpamphlettopublicizemammogramstotheirpatientpopulation
POLICYAdvocacyorganizationslobbyingforhealthcarecauses
AType2Diabetesorganizationmeetswiththemayortoadvocateforasugarybeveragetax
AdaptedfromCarmanKL,Dardess P,MaurerM,etal.Patientandfamilyengagement:aframeworkforunderstandingtheelementsanddevelopinginterventionsandpolicies.Healthaffairs.2013;32:223-31.
Copyright2019,TheRegentsoftheUniversityofCaliforniaCreatedbyUCSFCenterforExcellenceinPrimaryCare.
Whyshouldweengagepatients?• Justiceissue:shiftcontrolbacktohistoricallyoppressedpopulations
• Ethicalissue:It’stherightthingtodo
• Utilitarianissue:• HelpsforPCMHcertification• RequiredforFQHCs• Attractsconsumers• Itmakeshealthcareinterventionsmoreeffective(?)
Copyright2019,TheRegentsoftheUniversityofCaliforniaCreatedbyUCSFCenterforExcellenceinPrimaryCare.
Makingthecaseforpatientengagement:What’stheevidence?
Copyright2019,TheRegentsoftheUniversityofCaliforniaCreatedbyUCSFCenterforExcellenceinPrimaryCare.
DoesPatientEngagementAffectOutcomes?
• Strongerevidenceforindividual patientengagement• PatientActivationMeasure(PAM)• SharedDecisionMaking• Motivationalinterviewing• Healthcoaches
• Lessevidenceforclinic-level patientengagement• Butweareworkingonit….
HibbardandGreene.HealthAff 2013;Staceyetal.CochraneSyst Rev2011;Bennettetal.Fam Pract Manag.2010
Copyright2019,TheRegentsoftheUniversityofCaliforniaCreatedbyUCSFCenterforExcellenceinPrimaryCare.
SystematicReview:Results
• Results:639articlesfound,32selectedforfinalreview
1. 17casestudies/anecdotalimpactsonpatientsatisfaction,reducedfalls,improvementstoclinicandhospitallayouts
2. 4communitybasedstudies:improvedcolorectalcancerscreening,inhaleruse,BPcontrol
3. 1clusterRCT:patientadvisorsidentifiedprioritiesmorealignedwiththePCMHandChronicCareModel
Copyright2019,TheRegentsoftheUniversityofCaliforniaCreatedbyUCSFCenterforExcellenceinPrimaryCare.
Clinicaloutcomes• Coloradobasedqualityimprovementinitiativesof“bootcamptranslation”– communityadvisorshelpedtranslatehealthmessages• Bloodpressure• Asthma• PCMHmessaging• Colorectalcancerscreening
AnjanaSharma2018 13Copyright2019,TheRegentsoftheUniversityofCaliforniaCreatedbyUCSFCenterforExcellenceinPrimaryCare.
Clinicaloperations
• Customerservicetraining• Eveningaccess/drop-inhours• Feedbackonwebportals• Advancedirectivepacket
SharmaA,AngelL,BuiQ.PatientAdvisoryCouncils:GivingPatientsaSeatattheTable.Familypracticemanagement.2015Jul-Aug;22(4):22-7.SharmaAE,KnoxM,Mleczko VL,Olayiwola JN.Theimpactofpatientadvisorsonhealthcareoutcomes:asystematicreview.BMChealthservicesresearch.2017;17(1):693.
Copyright2019,TheRegentsoftheUniversityofCaliforniaCreatedbyUCSFCenterforExcellenceinPrimaryCare.
ABFMSurveyonPatientEngagement• Results:Familydocs(1,368)practicinginambulatorysetting
76.5%
52.9%
18.8% 23.8%
20.5%
31.1%
0%
20%
40%
60%
80%
100%
Surveys Suggestionboxes
Boardsofdirectors
Patientadvisorycouncils
PatientparticipationinQIactivities
Any"highintensity"approach
”lowintensity” ”highintensity”
Copyright2019,TheRegentsoftheUniversityofCaliforniaCreatedbyUCSFCenterforExcellenceinPrimaryCare.
ABFMSurveyonPatientEngagement
• Notables:• Patientexperiencesurveysarehighlyprevalent• Ofallpractices,31%havehigh-intensitypatientengagement• OfallPCMHs,58.5%havehigh-intensitypatientengagement
• WhatpredictsHIGH-INTENSITYPatientEngagement(patientsinQIorpatientadvisorycouncils):• Practicesize:aOR 3.30,95%CI(1.96,5.57)• PCMHstatus:
• CertifiedPCMHaOR 2.19(1.62,2.97)• %Vulnerablepopulationsserved:aOR 1.83(1.18,2.84)
Copyright2019,TheRegentsoftheUniversityofCaliforniaCreatedbyUCSFCenterforExcellenceinPrimaryCare.
Poll#3:Whatpatientengagementactivitiesdoyouhaveatyoursite?1. Patientadvisorycouncils2. Patientsonourgoverningboard3. Patientfeedbacksurveys4. PatientsbelongtoQIteams5. Townhallsorcommunitymeetings6. Informal,one-on-onefeedback
Copyright2019,TheRegentsoftheUniversityofCaliforniaCreatedbyUCSFCenterforExcellenceinPrimaryCare.
FamilyMedicineforAmerica’sHealth:PatientEngagementTacticTeam
Copyright2019,TheRegentsoftheUniversityofCaliforniaCreatedbyUCSFCenterforExcellenceinPrimaryCare.
Commonconcernsaboutpatientengagement
• Patientengagementisonlypossibleinsystemswithlotsofresources• Patientsandfamiliesaren’tinterestedorabletoprovidefeedbacktotheirclinic• There’snoreturnoninvestmentinengagingpatientsandfamilies• Patientengagementisn’tpossibleatmypracticebecause[___]
ProjectPurpose:Toidentifyandshareinnovativestrategiesforpatientengagementattheorganizationallevelindiverse practicesettings!
Copyright2019,TheRegentsoftheUniversityofCaliforniaCreatedbyUCSFCenterforExcellenceinPrimaryCare.
Whatdidwedo?
• Setting: InterviewedclinicleadersacrossNorthAmerica• Recruitment:Conveniencesamplingtoidentifypracticesrepresentingdiversegeographicregionsandpracticecharacteristics• Interview:Telephone-based,withinterviewguide• Aim: toassessorganizational-levelpatientengagement,howtheymadeitwork,andwhatimpactithad
Copyright2019,TheRegentsoftheUniversityofCaliforniaCreatedbyUCSFCenterforExcellenceinPrimaryCare.
Whatdidwefind?
21interviewswereconductedfrom2016to2017
13sitesdescribedorganizationallevel
ofpatientengagement
13casestudiesdeveloped
Copyright2019,TheRegentsoftheUniversityofCaliforniaCreatedbyUCSFCenterforExcellenceinPrimaryCare.
CaseStudySites
Copyright2019,TheRegentsoftheUniversityofCaliforniaCreatedbyUCSFCenterforExcellenceinPrimaryCare.
SiteDemographics
PracticeSetting Count(n=13)Rural 5
Urban 6
Suburban 2
PracticeType Count(n=13)
Private 5
Public 8
Academic 4
PracticeSize Count(n=13)
Small 3
Medium 5
Large 5
*Beinganacademicsitewasnotmutuallyexclusivewithbeingaprivate/publicsite
Copyright2019,TheRegentsoftheUniversityofCaliforniaCreatedbyUCSFCenterforExcellenceinPrimaryCare.
St.Michael’sHospitalAcademicFamilyHealthTeamToronto,Canada
Lowintensity
Highintensity
SiteProfile• Practicetype:Urbanacademicsite• Practicesize:Large(42,000patients)• Patientdemographics:Professional,youngfamilies,lowincome,immigrant,refugees
Whatdidtheydo?• Invited10,000patients;350volunteered!• Randomlyselected36(age,gender,housing,selfreportedhealth)• Patientengagementday– 1dayeventwherepatientsidentifiedpainpointsandprovidedrecommendations
Whatwastheresult?• Pagesofthoughtfulrecommendations(ex.Plexiglass,notunderstandingwhyresidentswouldleave)• Reenergizedpatientsandstaff• Demonstratedvalueofpatientengagement
“Manypeoplejumpintopatientadvisorycommitteesandtheymaynotalwaysbereadyforthat…Evenbringingpatientstogetherforadayisgreatanditwasgreatforourteam.”
– Dr.TaraKiran,DirectorofQualityImprovement
Copyright2019,TheRegentsoftheUniversityofCaliforniaCreatedbyUCSFCenterforExcellenceinPrimaryCare.
MedicalAssociatesClinicGlasgow,Kentucky
Lowintensity
Highintensity
SiteProfile• Practicetype: Rural,Independentclinic• Practicesize: Small(severalthousandpatients)• Patientdemographics:Rural,geriatric.Serves12countiesinAppalachianMountainregion
Whatdidtheydo?•Manypatientsnotbringingmedicationswasaproblemespeciallywithgeriatricpop.• PatientQualityCircles–quarterlyforumswherepatientscometogether• Broughtissuetoapatientqualitycirclemeeting
Whatwastheresult?• Onesuggestionwastoprintreminderonappointmentcards,whichresultedinmorepeoplebringingintheirmedications•Morepatientsnowvolunteertheirinputregardingclinicprocesses
Copyright2019,TheRegentsoftheUniversityofCaliforniaCreatedbyUCSFCenterforExcellenceinPrimaryCare.
HypertensionEquityGroupSanFrancisco,California
Lowintensity
Highintensity
SiteProfile• Practicetype:Urban,publichealthsystem• Practicesize:Large(currentlyservesover120,000individuals)• Patientdemographics:Underserved,safetynetpatientpopulation
Whatdidtheydo?• Patientsserveasactiveworkgroupmembers• Participateinmonthlymeetingstoreviewdataanddesignstrategies,presentedatmeetings
Whatwastheresult?
• Patientguidedinterventions• Homebloodpressuremonitoringtoolkit–moretailoredforB/AAcommunity• Foodpharmacy
•Missionstatement
Copyright2019,TheRegentsoftheUniversityofCaliforniaCreatedbyUCSFCenterforExcellenceinPrimaryCare.
Commonconcernsaboutpatientengagement
• Patientengagementisonlypossibleinsystemswithlotsofresources• Patientsandfamiliesaren’tinterestedorabletoprovidefeedbacktotheirclinic• There’snoreturnoninvestmentinengagingpatientsandfamilies• Patientengagementisn’tpossibleatmypracticebecause[___]
Misconceptions
Copyright2019,TheRegentsoftheUniversityofCaliforniaCreatedbyUCSFCenterforExcellenceinPrimaryCare.
Finalpoll:Whatinformationwasneworsurprisingforyou?
1. Patientorcommunityinputcanmakequalityimprovementprojectsmoreeffective
2. Overone-thirdoffamilymedicineclinicsintheUSareengagingpatientsinadvisorycouncilsorqualityimprovement
3. Patientengagementhappensatsoloandsmallpracticesaswellaslargerclinics
4. Patientengagementisabrandingstrategy-- itmayincreasepatientsatisfactionandconsumerretention
Copyright2019,TheRegentsoftheUniversityofCaliforniaCreatedbyUCSFCenterforExcellenceinPrimaryCare.
Conclusions• Patientadvisorsgeneratenovelideasforserviceimprovement.
•ThereisNOone-size-fits-allforpatientengagementatthecliniclevel.
• Patientengagementstrategiescanbetailoredtothecapacityoftheclinicandneedsofthecommunity.
Copyright2019,TheRegentsoftheUniversityofCaliforniaCreatedbyUCSFCenterforExcellenceinPrimaryCare.
Toolsforgettingstarted
Copyright2019,TheRegentsoftheUniversityofCaliforniaCreatedbyUCSFCenterforExcellenceinPrimaryCare.
“TOP10PATIENTENGAGEMENTTIPS”#10:Sendperiodicemailstoyourpatientstosharewellnesseducationandclinicupdates.#9:Holdaone-timepatientengagementdaywherefolkscanprovideinputandreceivehealtheducationinatownhall-styleformat.#8:Setupapatientadvisorycouncilandaskparticipantstodiscusssocialneedsthataffectthehealthoftheircommunity.#7:Askyourpatientadvisorycounciltobrainstormideastoreduceappointmentwaittimes.#6:Invitepatientadvisorstoproviderecommendationsonbrandingyourclinic.
Copyright2019,TheRegentsoftheUniversityofCaliforniaCreatedbyUCSFCenterforExcellenceinPrimaryCare.
“TOP10PATIENTENGAGEMENTTIPS”
#5:Involvepatientsinyourstrategicplan,missionandvision.#4:Includepatientadvisorsinqualityimprovement(QI)byputtingmembersonQIteamsandworkinggroups.#3:Considerhavingpatientadvisorsreviewaggregatedata,runchartsandhelpbrainstormnewQIprojects.#2:Haveyouradvisorycouncildiscussclinicprotocolsforspecificdiseases,suchasHIVinfectionanddiabetes.#1:Askyourpatientadvisorstosharetheirstoriesofstructuralracismanddiscusshowracisminmedicineaffectshealthoutcomes.
Copyright2019,TheRegentsoftheUniversityofCaliforniaCreatedbyUCSFCenterforExcellenceinPrimaryCare.
Nextstepstolearnmore
• Tookits,videos,andmoreat• https://cepc.ucsf.edu/patients-transformation-partners
• InstituteforPatientandFamily-CenteredCare• http://www.ipfcc.org/
• AgencyforHealthcareResearchandQuality• https://www.ahrq.gov/professionals/quality-patient-safety/patient-family-engagement/index.html
Copyright2019,TheRegentsoftheUniversityofCaliforniaCreatedbyUCSFCenterforExcellenceinPrimaryCare.
Acknowledgements• Participatingsitesandtheirpatientpartners• CFARTeam(Mal,ChristianCarman,WyattGolledge)• FMAHealth EngagementTacticTeamMembers• CarolynGaughan,CAE,KAFP• SusanHogeland,CAFP• AAFPandACOFP,andallmemberorganizationsofFMAHealth
Copyright2019,TheRegentsoftheUniversityofCaliforniaCreatedbyUCSFCenterforExcellenceinPrimaryCare.
Thankyou!Let’scontinuetheconversation:
#PatientEngagementDay2019,#PatientEngagement
AnjanaSharmaanjana.sharma@ucsf.edu - @AJSharmaMDCenterforExcellenceinPrimaryCare- @UCSFCEPC
DepartmentofFamily&CommunityMedicineUniversityofCalifornia,SanFrancisco
Copyright2019,TheRegentsoftheUniversityofCaliforniaCreatedbyUCSFCenterforExcellenceinPrimaryCare.