Medical Informatics Officer New York Hospital Queens, New York
People who are engaged in managing their health and healthcare can have better outcomes and lower healthcare costs. In a study of more than 30,000 patients at a healthcare system in Minnesota, Judith Hibbard et al. found that patients with low activation scores had costs that are eight to 21 per cent higher than patients with the highest activation levels.
If you Google ‘Patient Engagement’ you will get more than 7.8 million results. Among the results are related terms like ‘Patient-Centered Care’, ‘Person-Centered Engagement’, and ‘Consumer Engagement’.
While the variety of these terms can be bewildering, more than a decade ago the Institute of Medicine Report ‘Crossing the Quality Chasm’ recognised that they all embrace ‘qualities of compassion, empathy, and responsiveness to the needs, values, and expressed preferences of the individual patient.’
A review of some of the current definitions reveals their commonality.
Despite their similarities, there are nuanced differences. For example, the American Association of Retired Persons advocates the adoption of ‘person’ rather than ‘patient’ since it includes the ‘whole person’ beyond the individual’s interaction with healthcare.
Population health mirrors this perspective. The World Health Organization estimates that removing the risk factors for chronic disease would prevent at least 80 per cent of heart disease, stroke, and type-2 diabetes; and 40 per cent of cancer cases. This means engaging people before they become ill, which in public health is known as primary prevention. As Benjamin Franklin said, ‘An ounce of prevention is worth a pound of cure’.
As promising as the terms person-, consumer-, and patient-centered engagement are, they face several challenges.
The Center for Advancing Health polled a sample of health leaders who cited both systemic and personal barriers:
· People live their lives outside of clinical settings.
· Stress is high, in part due to many demands on personal, professional, and institutional resources.
· Trust and communications between various stakeholders can be suboptimal.
· The 'old school' culture—that providers are the experts, and patients should be submissive—persists.
· Habit (or inertia for institutions) is a mighty force to overcome.
Personal barriers include:
· Insufficient prerequisites, i.e., mindset not ready for personal activation; knowledge of insurance benefits, variances in quality and cost, and health literacy; and, skills like being able to comparison shop healthcare providers
· Health problems, including depression, pain, poor health, and disabilities, to name a few
· Non-health complications in life from financial instability to abusive relationships to unemployment, and other difficulties associated with what Amber Haley, Virginia
· Commonwealth University Center on Human Needs, called 'low-resource, high-stress environments'
· Language and cultural differences.
· The overarching solution to these barriers expressed by many interviewed in the report was described by Steven E Weinberger, American College of Physicians: “To get better engagement, a push needs to come from both the clinician and the patient side—each interacting with the other.”
LET’S DO IT: Healthcare providers
Patient and family engagement are fundamental to healthcare models such as the Patient-Centered Medical Home and Meaningful Use of EHR.
Two of the nine standard categories of the National Committee for Quality Assurance Patient-Centered Medical Home Recognition facilitate patient engagement: Access and Communication and Patient Self-Management and Support.
Meaningful Use includes objectives that enable patients to view, download, and transmit their health information and for providers to provide EHR-generated patient-specific education resources.
The Healthcare Information Management & Systems Society promotes the Patient Engagement Framework, a model crafted to guide healthcare organisations advancing patient engagement through the use of health information technology. The framework is aligned with Meaningful Use.
LET’S DO IT: People, consumers, & patients
According to Google’s Mobile Planet, smartphone penetration is growing across the planet. In their 2013 report of forty-seven countries, the average penetration was 44.6 per cent (range 12.8 to 73.8 per cent).
Smartphone adoption is growing across many sectors of the population. It may not be surprising that a 2014 Nielsen survey in the United States found that 85 per cent of millennials own smartphones. However, they are not alone. Some 171.5 million people (71%) in the United States own such a smartphone. The proportion of men and women in the US with smartphones is similar (70 per cent and 72 per cent, respectively).
Multicultural consumers are adopting smartphones at a higher rate than average in the US Seventy-eight per cent of Asian Americans, 77 per cent of Latino-Americans, and 73 per cent of African-Americans have smartphones.
From the person’s perspective, Jan Oldenburg offers six categories for personal activation: Communications, Convenient self-service, Personal health information, Personal health information, Financial, Education and Support, and, General Capabilities