Researchers at NYU Langone conducted experiments to test small improvements to patient engagement strategy.
In the era of value-based care and patient engagement, medical professionals are consistently looking for strategies to ensure their patient outreach efforts are truly effective.
As reimbursement is increasingly tied to value, more healthcare providers are creating systems for engaging their patients, getting patients into the office for routine medical care, prompting healthy behavior change, and delivering follow-up care. These strategies, experts say, will be critical for creating a culture of wellness and delivering on value-based care principles.
But the medical industry is also calling for something else: continuous improvement. Healthcare is defined by a constant drive to do better and achieve better patient outcomes.
How can providers work to ensure their patient engagement strategies are truly the best and most effective?
At NYU Langone, researcher Leora Horwitz, MD, an associate professor in the departments of Population Health and Medicine, said improvement relies on constant testing. And her research, recently published in the New England Journal of Medicine, confirms that small, randomized changes to patient engagement protocol can yield actionable insights.
“This program is important because there are always better ways to do things, but unless we have some data to show us that what we’re doing is not fully effective, we have no incentive or inclination to find a better way to do it,” Horwitz, who is also the director of the Center for Healthcare Innovation and Delivery Science, said.
“Unless we study whether what we’re doing is working, we cannot allocate the resources that we have most effectively. And that means we’re not necessarily providing the best possible care to our patients.”
Horwitz and her team investigated patient engagement strategy efficacy by testing small changes in protocol for improving post-discharge care, patient outreach for preventive screening, collection of patient-reported outcomes, and increasing smoking cessation counseling.
For example, the researchers randomly selected certain patients to no longer receive follow-up calls after hospital discharge. This test found that follow-up calls are not always effective. Follow-up rates and satisfaction scores among patients who did not receive calls were similar to those who did receive calls, indicating that providers may only need to follow up with high-risk patients, if call any patients at all.
Another test looked at the language providers used during calls to schedule annual wellness visits. Two scripts were used in alternating weeks between two patient cohorts, and revealed differences in effectiveness and efficiency. For example, new language to prompt smoking cessation counseling increased the rates of medication prescriptions.
The new script also cut down on the time it took to make the calls and increased the number of patients coming in for well visits, indicating to providers that more effective language can be chosen to promote healthy patient behavior.
Collecting this type of information will allow patient engagement experts at NYU Langone begin to design better patient-centered outreach protocol, thus allowing the organization to constantly improve patient care quality, said Andrew W. Brotman, MD, the senior vice president and vice dean for clinical affairs and strategy at NYU Langone.
“At NYU Langone Health, the wellbeing of our patients always comes first,” Brotman asserted. “To fulfill our role as a learning health system, we must demonstrate the agility to adapt or modify any procedure so that it delivers maximum benefit to patients. Dr. Horwitz’s work ensures we are allocating staff resources in the most effective manner possible.”
Of course, there are some ethical questions the research team had to confront. In doing these randomized trials, the researchers had to account for knowingly delivering their patients potentially lower-quality care – like when they stopped doing follow-up phone calls, for example.
But because these changes were so minor, hospital workers were able to stay agile, Horwitz and her team said. Once the researchers determined what did and did not work – one preventive care outreach script over another, for example – they were able to still deliver the more effective form of care to all of their patients.
Understanding which patient engagement strategies work best is a part of the organization’s ethical call to action to better serve patients, Horwitz acknowledged.
“I believe we have an ethical responsibility to rigorously assess whether our operational interventions are effective, even when they may seem trivial, such as scripts for calls or mailings that we send to people to get them to get their colonoscopy,” she stated. “If we don’t, we can’t be sure we are doing the best by our patients.”
Results for different randomized tests will likely vary between organizations. What one patient population may respond to could be different for another population. However, these latest tests from NYU Langone demonstrate the feasibility of conducting randomized experiments on patient outreach efforts.
Other hospitals can conduct similar experiments easily, helping them to find their own perfect patient engagement formula.
“This can be done quite easily. It doesn’t have to be a $10 million, 10-year National Institutes of Health trial,” Horwitz concluded. “We can build these things into the routine way we do our work.”
Date: October 07, 2019