Can a patient go from 132 visits to an emergency department in one year to zero visits in 10 months? Would it take a major corrective surgery or a new cure-all drug to accomplish this feat? Actually, in the case of one accountable care organization (ACO), it took a ramp and a refrigerator.
This is an example of the potential of patient engagement—where a medical group helps engage patients and families in their own care through a combination of outreach, communication, shared decision making, self-management programs, and quality improvement activities. In this instance, the patient was in a wheelchair and was diabetic, but lived in a house with no ramp or a refrigerator for her insulin. The ACO built her a ramp and got her a donated refrigerator, among other quality improvements, resulting in the reduced emergency room visits.
Patient and family engagement (PAE) can reduce the cost of care and has an additional benefit of being associated with better outcomes of care. So it’s a win-win for medical groups and the patients they serve. But how well are ACOs engaging patients and can they do better? A study led by researchers from the UC Berkeley School of Public Health’s Center for Healthcare Organizational and Innovation Research (CHOIR) aimed to find out.
“There isn’t a lot of information available on how well ACOs are engaging patients and families in their care,” says Professor Stephen Shortell, lead author of the study and faculty director of CHOIR. “So we examined their efforts, identified challenges to patient engagement, and developed some potential strategies to address these challenges.
Researchers analyzed current levels of PAE using a combination of early assessment data from a national survey, phone interviews from a subsample of 11 ACOs, and site visits to two additional ACOs. They found that vast majority of ACOs are participating in PAE through reminder notices and follow-up calls or emails to their patients, and by allowing patients access to their own medical records. But only about half of primary care physicians had received training in PAE techniques or shared decision-making practices. And only about 45 percent of the high-risk, chronically ill patients received health coaching.
“Through the surveys and interviews, we found that most respondents felt strongly that an investment in patient engagement would lead to improved quality of care, retention of patients, and lower cost of care,” says Shortell. “We also saw a theme emerge that many of these organizations are trying to improve PAE by improving care coordination, patient communication, and outreach.”
Some of the challenges in implementing PAE strategies are familiar ones—competing priorities, resource constraints, and lack of time. Also limited data on what patients want and what really works, as well as difficulties in conducting return on investment analyses. Only 26 percent of the ACOs that responded to the surveys were able to do any ROI calculations.
“Many of these interventions have so many effects on so many different aspects of patient care it’s difficult to quantify the direct impact,” wrote one respondent.
ACOs, which are medical groups that are held accountable for meeting cost and quality criteria, are likely to be ahead of non-ACOs in engaging patients and their families. Strategies for improving PAE investigated by the researchers included an emphasis on teams, widespread training, frequent monitoring and reporting, and, last but not least, patience.
“The two ACOs we visited recognized that increasing these activities is an ongoing, long-term commitment,” says Shortell, “one that will take time and continual attention.”
CHOIR will remain committed to long-term research into PAE as well.
The study was published in the journal, Medical Care Research and Review, in June. CHOIR coauthors were Neil Sehgal, Salma Bibi, and Patricia Ramsay. Other coauthors are Linda Neuhauser, clinical professor at the UC Berkeley School of Public Health, and Carrie Colla and Valerie Lewis, both at the Geisel School of Medicine, Dartmouth College. This work was funded by the Gordon and Betty Moore Foundation and the Commonwealth Fund.
By Linda Anderberg