Patient engagement in primary care · 2019-04-04 · Conclusions •Patient advisors generate novel...

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Patient engagement in primary care: How family physicians can partner with patients Anjana Sharma, MD MAS Beatrice Huang| Mal O’Connor, Ph.D | Rachel Willard-Grace, MPH | Kevin Grumbach, MD Family Medicine for America’s Health: Patient Engagement Day Webinar presentation April 4, 2019 Copyright 2019, The Regents of the University of California Created by UCSF Center for Excellence in Primary Care.

Transcript of Patient engagement in primary care · 2019-04-04 · Conclusions •Patient advisors generate novel...

Page 1: Patient engagement in primary care · 2019-04-04 · Conclusions •Patient advisors generate novel ideas for service improvement. •There is NO one-size-fits-all for patient engagement

Patientengagementinprimarycare:Howfamilyphysicianscanpartnerwithpatients

AnjanaSharma,MDMASBeatriceHuang|MalO’Connor,Ph.D |RachelWillard-Grace,MPH| KevinGrumbach,MD

FamilyMedicineforAmerica’sHealth:PatientEngagementDayWebinarpresentation

April4,2019

Copyright2019,TheRegentsoftheUniversityofCaliforniaCreatedbyUCSFCenterforExcellenceinPrimaryCare.

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AboutUs

AnjanaSharma,MDMASAssistantProfessorofFamily&CommunityMedicine

BeatriceHuangProjectManager,Analyst

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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

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Page 4: Patient engagement in primary care · 2019-04-04 · Conclusions •Patient advisors generate novel ideas for service improvement. •There is NO one-size-fits-all for patient engagement

Overview

• Whatispatientengagement?

• Evidencebaseforpatientengagement

• FamilyMedicineforAmerica’sHealthcasestudies

• Toolsforgettingstarted

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Patientengagementisahot topic!

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Whatispatientengagement?

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Poll#2:Whatisyourdefinitionofpatientandfamilyengagement?1. Patientadherenceorcompliancewithmedicalcare2. Digitalportalsordigitalappstoimprovehealth3. Healthliteracy4. Patientfeedback,insurveysorinadvisorycouncils5. Communityinputintohealthcareneeds6. Patientadvocacyforhealthcarelawsandpolicies

Hint:allofthesearecorrect,butwhichisclosestforYOU?

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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.

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Whyshouldweengagepatients?• Justiceissue:shiftcontrolbacktohistoricallyoppressedpopulations

• Ethicalissue:It’stherightthingtodo

• Utilitarianissue:• HelpsforPCMHcertification• RequiredforFQHCs• Attractsconsumers• Itmakeshealthcareinterventionsmoreeffective(?)

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Page 10: Patient engagement in primary care · 2019-04-04 · Conclusions •Patient advisors generate novel ideas for service improvement. •There is NO one-size-fits-all for patient engagement

Makingthecaseforpatientengagement:What’stheevidence?

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Page 11: Patient engagement in primary care · 2019-04-04 · Conclusions •Patient advisors generate novel ideas for service improvement. •There is NO one-size-fits-all for patient engagement

DoesPatientEngagementAffectOutcomes?

• Strongerevidenceforindividual patientengagement• PatientActivationMeasure(PAM)• SharedDecisionMaking• Motivationalinterviewing• Healthcoaches

• Lessevidenceforclinic-level patientengagement• Butweareworkingonit….

HibbardandGreene.HealthAff 2013;Staceyetal.CochraneSyst Rev2011;Bennettetal.Fam Pract Manag.2010

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SystematicReview:Results

• Results:639articlesfound,32selectedforfinalreview

1. 17casestudies/anecdotalimpactsonpatientsatisfaction,reducedfalls,improvementstoclinicandhospitallayouts

2. 4communitybasedstudies:improvedcolorectalcancerscreening,inhaleruse,BPcontrol

3. 1clusterRCT:patientadvisorsidentifiedprioritiesmorealignedwiththePCMHandChronicCareModel

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Clinicaloutcomes• Coloradobasedqualityimprovementinitiativesof“bootcamptranslation”– communityadvisorshelpedtranslatehealthmessages• Bloodpressure• Asthma• PCMHmessaging• Colorectalcancerscreening

AnjanaSharma2018 13Copyright2019,TheRegentsoftheUniversityofCaliforniaCreatedbyUCSFCenterforExcellenceinPrimaryCare.

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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.

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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”

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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)

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Poll#3:Whatpatientengagementactivitiesdoyouhaveatyoursite?1. Patientadvisorycouncils2. Patientsonourgoverningboard3. Patientfeedbacksurveys4. PatientsbelongtoQIteams5. Townhallsorcommunitymeetings6. Informal,one-on-onefeedback

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FamilyMedicineforAmerica’sHealth:PatientEngagementTacticTeam

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Commonconcernsaboutpatientengagement

• Patientengagementisonlypossibleinsystemswithlotsofresources• Patientsandfamiliesaren’tinterestedorabletoprovidefeedbacktotheirclinic• There’snoreturnoninvestmentinengagingpatientsandfamilies• Patientengagementisn’tpossibleatmypracticebecause[___]

ProjectPurpose:Toidentifyandshareinnovativestrategiesforpatientengagementattheorganizationallevelindiverse practicesettings!

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Whatdidwedo?

• Setting: InterviewedclinicleadersacrossNorthAmerica• Recruitment:Conveniencesamplingtoidentifypracticesrepresentingdiversegeographicregionsandpracticecharacteristics• Interview:Telephone-based,withinterviewguide• Aim: toassessorganizational-levelpatientengagement,howtheymadeitwork,andwhatimpactithad

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Whatdidwefind?

21interviewswereconductedfrom2016to2017

13sitesdescribedorganizationallevel

ofpatientengagement

13casestudiesdeveloped

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Page 22: Patient engagement in primary care · 2019-04-04 · Conclusions •Patient advisors generate novel ideas for service improvement. •There is NO one-size-fits-all for patient engagement

CaseStudySites

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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

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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

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MedicalAssociatesClinicGlasgow,Kentucky

Lowintensity

Highintensity

SiteProfile• Practicetype: Rural,Independentclinic• Practicesize: Small(severalthousandpatients)• Patientdemographics:Rural,geriatric.Serves12countiesinAppalachianMountainregion

Whatdidtheydo?•Manypatientsnotbringingmedicationswasaproblemespeciallywithgeriatricpop.• PatientQualityCircles–quarterlyforumswherepatientscometogether• Broughtissuetoapatientqualitycirclemeeting

Whatwastheresult?• Onesuggestionwastoprintreminderonappointmentcards,whichresultedinmorepeoplebringingintheirmedications•Morepatientsnowvolunteertheirinputregardingclinicprocesses

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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

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Page 27: Patient engagement in primary care · 2019-04-04 · Conclusions •Patient advisors generate novel ideas for service improvement. •There is NO one-size-fits-all for patient engagement

Commonconcernsaboutpatientengagement

• Patientengagementisonlypossibleinsystemswithlotsofresources• Patientsandfamiliesaren’tinterestedorabletoprovidefeedbacktotheirclinic• There’snoreturnoninvestmentinengagingpatientsandfamilies• Patientengagementisn’tpossibleatmypracticebecause[___]

Misconceptions

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Page 28: Patient engagement in primary care · 2019-04-04 · Conclusions •Patient advisors generate novel ideas for service improvement. •There is NO one-size-fits-all for patient engagement

Finalpoll:Whatinformationwasneworsurprisingforyou?

1. Patientorcommunityinputcanmakequalityimprovementprojectsmoreeffective

2. Overone-thirdoffamilymedicineclinicsintheUSareengagingpatientsinadvisorycouncilsorqualityimprovement

3. Patientengagementhappensatsoloandsmallpracticesaswellaslargerclinics

4. Patientengagementisabrandingstrategy-- itmayincreasepatientsatisfactionandconsumerretention

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Conclusions• Patientadvisorsgeneratenovelideasforserviceimprovement.

•ThereisNOone-size-fits-allforpatientengagementatthecliniclevel.

• Patientengagementstrategiescanbetailoredtothecapacityoftheclinicandneedsofthecommunity.

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Toolsforgettingstarted

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Page 31: Patient engagement in primary care · 2019-04-04 · Conclusions •Patient advisors generate novel ideas for service improvement. •There is NO one-size-fits-all for patient engagement

“TOP10PATIENTENGAGEMENTTIPS”#10:Sendperiodicemailstoyourpatientstosharewellnesseducationandclinicupdates.#9:Holdaone-timepatientengagementdaywherefolkscanprovideinputandreceivehealtheducationinatownhall-styleformat.#8:Setupapatientadvisorycouncilandaskparticipantstodiscusssocialneedsthataffectthehealthoftheircommunity.#7:Askyourpatientadvisorycounciltobrainstormideastoreduceappointmentwaittimes.#6:Invitepatientadvisorstoproviderecommendationsonbrandingyourclinic.

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“TOP10PATIENTENGAGEMENTTIPS”

#5:Involvepatientsinyourstrategicplan,missionandvision.#4:Includepatientadvisorsinqualityimprovement(QI)byputtingmembersonQIteamsandworkinggroups.#3:Considerhavingpatientadvisorsreviewaggregatedata,runchartsandhelpbrainstormnewQIprojects.#2:Haveyouradvisorycouncildiscussclinicprotocolsforspecificdiseases,suchasHIVinfectionanddiabetes.#1:Askyourpatientadvisorstosharetheirstoriesofstructuralracismanddiscusshowracisminmedicineaffectshealthoutcomes.

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Page 33: Patient engagement in primary care · 2019-04-04 · Conclusions •Patient advisors generate novel ideas for service improvement. •There is NO one-size-fits-all for patient engagement

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

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Page 34: Patient engagement in primary care · 2019-04-04 · Conclusions •Patient advisors generate novel ideas for service improvement. •There is NO one-size-fits-all for patient engagement

Acknowledgements• Participatingsitesandtheirpatientpartners• CFARTeam(Mal,ChristianCarman,WyattGolledge)• FMAHealth EngagementTacticTeamMembers• CarolynGaughan,CAE,KAFP• SusanHogeland,CAFP• AAFPandACOFP,andallmemberorganizationsofFMAHealth

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Page 35: Patient engagement in primary care · 2019-04-04 · Conclusions •Patient advisors generate novel ideas for service improvement. •There is NO one-size-fits-all for patient engagement

Thankyou!Let’scontinuetheconversation:

#PatientEngagementDay2019,#PatientEngagement

[email protected] - @AJSharmaMDCenterforExcellenceinPrimaryCare- @UCSFCEPC

DepartmentofFamily&CommunityMedicineUniversityofCalifornia,SanFrancisco

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Patient Engagement Quality Guidance Tool · Patient ocused edicines Development I ade WITH Patients I 4/17 Section 2: The quality of patient engagement Consider the Patient Engagement

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