Organizations with a strong team-based care infrastructure are better positioned for setting up patient engagement programming.
Healthcare organizations with clinician leaders and a strong, team-based approach tend to be better at getting patient engagement initiatives off the ground than those with fewer staffing resources, according to research published in the Annals of Family Medicine.
More specifically, organizations with provider champions, that have clear-cut staff duties, that conduct team huddles to discuss performance improvement, and that employ staff members dedicated specifically to patient engagement tend to be more successful.
“Patient engagement is a relationship-based approach that builds trust and promotes patient autonomy by actively involving and supporting patients in health care and treatment decision making,” the researchers began.
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At the Veterans Health Administration (VA), those efforts culminated in the Patient-Aligned Care Team (PACT) initiative, which leveraged certain aspects of the patient-centered medical home model to improve patient engagement and autonomy. Specifically, VA organizations focused on putting the patient at the center of care and the changes in patient-provider relationships necessary at facilitating that model.
What was less apparent were the organizational levers needed to make that new, patient-centered relationship a reality.
“Team-based care is a key driver of the use of patient engagement care processes and may directly affect patients’ level of engagement,” the researchers wrote. “Factors related to patients, team members, and workload may moderate the influence of team-based care on use of patient engagement care processes.”
Foremost, the researchers wanted to know just how widespread adoption of different PACT principles became. Using the 2016 PACT survey, which fielded responses from nearly 2,500 clinicians at over 600 clinics nationwide, the researchers found that organizations only modestly implemented patient engagement best practices.
Looking specifically at patient care planning, motivational interviewing, and organization programs for patient self-management, the team found some best practices were adopted more than others.
While most organizations adopted strategies to enable better patient care planning, motivational interviewing and self-management programming received a more tepid response.
“Lower use of these practices may be related to clinicians’ perceptions that some elements of the patient-centered medical home may not be entirely relevant (or may be difficult to use) for particular groups of patients during visits,” the researchers offered.
From there, the research team looked at commonalities among organizations that had successfully implemented patient engagement strategy.
Organizations that embraced patient engagement usually had direct care clinicians endorsing those best practices, the researchers found.
Additionally, having an adequate staff dedicated to patient engagement likewise increased the odds of a successful patient engagement strategy rollout. Specifically, patient engagement staff made it easier for organizations to conduct care planning with patients and design organizational programs to facilitate self-management.
This could pose a future challenge for VA clinics, the researchers acknowledged. PACT programming recommended organizations hire three patient engagement staffers for each primary care provider focusing on patient engagement. However, that recommendation rarely came to fruition.
“Inadequately staffed teams and high turnover contribute to burnout of VHA primary care personnel and make it difficult to establish relationships among team members, reconfigure roles and responsibilities, and develop new work processes, including those related to patient engagement,” the researchers said.
Notably, having clear staffing roles was also largely tied to better adherence to patient engagement strategy, mainly motivational interviewing and organizational programming. When organizations blur the lines between different clinical roles and responsibilities, it may be more likely those responsibilities fall through the cracks, the researchers posited.
Finally, the researchers observed a pattern in team-based huddles focusing on practice improvement, as well as clear patient engagement champions within each organization. Champions became responsible for spreading the organization’s vision for patient-centered care and engaging colleagues in promoting it.
Team-based huddles were also key for communicating quality improvement data and reviewing areas for improvement, the researchers reported.
“Improved team collaboration and coordination are necessary for practices to manage the increasing complexity and unpredictability of clinical care and to become more accountable for patient-centered outcomes,” they said.
Moving forward, researchers may look at the specific areas of the patient-centered medical home model that more effectively improve engagement than others. By determining improvements in patient activation, shared decision-making, and patient self-management, organizations can more judiciously deploy aspects of the patient-centered medical home.
Source: Patient Engagement Hit