4 Key factors in patient engagement

Patient engagement: It’s something all providers want to improve to create better patient outcomes and patient experience scores.

Hospitals and health systems that are on the leading edge of patient engagement activities often reap the rewards of satisfied patients, better referrals and improved transitions among care settings.

One of the challenges clinicians face is appropriately matching the right engagement resources with the patient needs at the right time. So much of what is required depends on a person’s level of readiness, or their capacity to be engaged in owning their care journey. What’s needed is an evidence-based metric that measures the components of patient engagement in one comprehensive, aggregate tool. Once that metric is known, then hospitals and health systems can develop specific patient and family engagement strategies to address patient needs, so they can be met “where they are” in their care journey. At the O’Neil Center, a research institute whose mission is to advance the science of patient and family engagement, we conducted a multi-site research instrumentation to develop an index that effectively measures a person’s capacity to be engaged. Based on that index score, we are now matching interventions delivered through technology for patient and family engagement activities. Our work is helping to answer the question: What are the interventions that make a difference to help patients achieve better clinical outcomes?

During our inquiry into the evidence, we discovered some gaps. There was no clear process model for ‘how’ to effectively engage patients in their care. Additionally, there was a gap in the measurement science of patient and family engagement. There were multiple measurement tools for many different elements impacting patient engagement, but no one comprehensive measure of a person’s capacity to engage in their care.

To address this gap, we developed a peer-reviewed, multi-disciplinary model—called the Interactive Care Model©—that helps guide every instance when clinicians interact with patients. The first step in implementing this model is to determine the capacity of a particular patient to be engaged in his or her care.

Next, we identified several factors that influenced whether people had the capacity to be engaged. There was no one metric that determined this, so we needed to determine the key elements of patient engagement readiness, to help create a psychometrically sound measurement tool that would be reliable and valid. After conducting a multi-site research study, the final instrument has 18 items and 4 subscales that are all valid and reliable. This important data index will guide a critical piece of the patient care journey – a person’s capacity to be engaged in their care. We envision the knowledge of a Person Engagement Index (PEI)® score as an integral part of clinical assessment data and available in patient charts and EHRs for millions of patients across the country. Armed with a unique, patient-centered data point, clinicians will be empowered in real-time to prescribe and implement more personalized interventions.

As hospitals and health systems invest in patient engagement tools, it’s important to make sure those resources are directed to the patients who are most likely to benefit. Here are the four crucial areas the PEI measures to assess a patient’s capacity to engage:

• Willingness to be involved

This assessment includes factors like: Will the patient challenge clinicians if they fail to engage in proper hand-washing, or ask about fall-prevention techniques? The capacity to do these things depends, in part, on how confident the patient is about communicating directly and honestly with his or her caregiver, to advocate for safe care at all times. This stance may be new and unfamiliar for patients who view clinicians as authority figures and may even feel intimidated by them.

• Willingness to take a proactive approach

A person’s willingness to engage in prevention activities, such as exercise, diet and positive health activities will impact their health outcomes. In addition, medication regimen protocols that need to be followed require a person to be proactive in taking their preventive medications every day. Knowing a person’s willingness to take a proactive approach will contribute to the impact of health outcomes.

• Technology adaptability

Patients will have a variety of attitudes and approaches towards managing their health conditions. Patient engagement efforts must center on meeting patients where they are to offer as much education and support as they want and can handle. It must be offered at the right time, at the right cadence and via the preferred communication channel to be effectively absorbed. An important consideration is the patient’s comfort level and access to different types of technology. For instance, if a patient uses a flip phone (4% of the population still have one), important messages about care management and education should not include hyperlinks.

• Availability of psychosocial support

Key for success in prevention efforts is the level of psychosocial support available to patients to help them stay on track and maintain an optimistic outlook. Caregivers and clinicians typically include some details regarding a patient’s social and environmental circumstances when documenting patient histories. However, these records often fail to reveal important nuances impacting patient health. For example, EHRs and claims data include basic demographic information but do not necessarily reveal that a patient resides in a neighborhood that lacks access to affordable healthy food, or in an area with a high crime rate. Without knowledge of such details, providers may miss essential information on factors that impact a patient’s health and may prescribe a treatment plan that is inappropriate or unachievable.

By focusing on these four areas, clinicians can assess patients’ capacity to engage in their own care, and identify the best interventions for each patient to maximize their own capabilities. Clinicians need to meet patients where they are in their ability to be engaged in their care journey and engagement efforts need to be tailored to that need. This will help maximize a hospital’s investment in time and resources. Importantly, by assigning a “score” to each patient—the Patient Engagement Index—clinicians can have a single quantifiable way to rate patients, so that improvement in these scores can be obtained. After all – as Peter Drucker said – if you can’t measure it, you can’t improve it.

Karen Drenkard, Ph.D., RN, NEA-BC, FAAN, is senior vice president and chief clinical and nursing officer at GetWellNetwork.

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