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Patient Engagement in Design, Delivery, & Discovery 8 th Annual Utah Health Services Research Conference February 25, 2013. Lucy A. Savitz , Ph.D., MBA Director, Research and Education Institute for Healthcare Delivery Research Intermountain Healthcare

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Patient Engagement in Design, Delivery, & Discovery8th Annual Utah Health Services Research ConferenceFebruary 25, 2013

Lucy A. Savitz, Ph.D., MBA

Director, Research and Education

Institute for Healthcare Delivery Research

Intermountain Healthcare

Research Professor, Epidemiology Division, Internal Medicine

Director, Community Engagement Core, CCTS

University of Utah

susan dentzer editor in chief health affairs 32 2 202
Susan Dentzer,, Editor-in-Chief, Health Affairs, 32(2): 202.

The ‘blockbuster drug of the century’ revealed in this issue!

the drug is actually a concept1
The ‘drug’ is actually a concept…
  • Patient activation & engagement
many ways to define the concept
Many ways to define the concept…
  • Patient engagement: actions that people take for their health and to benefit from care (IHI)
  • Patient activation: understanding one’s own role in the care process and having the knowledge, skills, and confidence to take on that role (Hibbard et al.)
shared decision making
Shared Decision Making
  • Intended to improve patient knowledge & involvement in decision-making to promote an informed, value-based choice among 2 or more medically reasonable alternatives(O’Connor et al.)
patient engagement in knowledge involvement about care
Patient Engagement in Knowledge & Involvement about Care

Shared

Patient Decision

Activation Making |______________________________|

Savitz, LA

holistic view of patient engagement
Holistic View of Patient Engagement
  • More holistic definitions broaden the concept further to encompass care delivery, design & research/discovery
  • Patients as partners
    • Personal responsibility & self-management
    • Quality improvement
      • (< 1/3 patients involved patient-centered medical home QI)
    • Care design
      • (e.g., mobile apps)
    • Governance
cmmi hospital engagement network assessment of engagement
CMMI & Hospital Engagement Network Assessment of Engagement
  • Prior to admission, hospital staff provides and discusses a discharge planning checklist with every patient that has a scheduled admission, allowing questions or comments from the patient or family.
  • Hospitals conduct both shift change huddles for staff & do bedside reporting with patients & family members in all feasible cases.
  • Hospital has a dedicated person or functional area that is proactively responsible for Patient and Family Engagement and systematically evaluates engagement activities.
  • Hospital has an active Patient and Family Engagement Committee OR at least one former patient that serves on a patient safety or quality improvement committee or team.
  • Hospital has one or more patient(s) who serve on a Governing and/or Leadership Board serving as a patient representative.
patient engagement is one strategy to achieve the triple aim
Patient engagement is one strategy to achieve the "triple aim”
  • A growing body of evidence demonstrates that patients who are more actively involved in their health care experience
    • better health outcomes
    • Improved satisfaction
    • lower cost
what will it take to move from here to there design delivery or discovery
What Will It Take to Move from Here to There: Design, Delivery, or Discovery
  • Need for training
    • Physicians
    • Clinical and non-clinical staff
    • Patients, families, caregivers
  • It takes a team-based approach
  • Culture change
    • Common language
    • Viewing patients/caregivers as partners
  • Evidence that engagement makes a difference
some hsr challenges
Some HSR Challenges
  • Engagement as anew approach to research
  • Limited/lacking tools to capture engagement
  • More research needed to understand:
    • How engagement leads to improved outcomes
    • Where engagement is best placed (setting, timing)
    • What should be offered
      • nudging vs. balanced, nondirective decision aids
    • Ways to engage all patients (literacy)
    • Ethical implications of engagement
      • abandonment or penalties for non-adherent patients
patient centered outcomes research institute pcori
Patient Centered Outcomes Research Institute (PCORI)
  • www.pcori.org
  • ACA mandates that PCORI seek meaningful ways to integrate the patient’s voice into the research process
    • Generate topics for research
    • Help to prioritize topics
    • Select topics for funding
    • Ensure patient involvement in design
local resources
Local Resources
  • Community Engagement Core of the Center for Clinical and Translation Services (CCTS)
  • Patient Centered Outcomes /Comparative Effectiveness Research Certificate Program
  • Patient Centered Outcomes Research Class, University of Utah School of Medicine, offered First Summer Session Annually
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