The February 2013 issue of the journal Health Affairs, supported by the California Health Care Foundation, explores “patient engagement” — loosely defined as involving patients in their care. Many believe that empowering patients to actively process information, decide how that information fits into their lives, and act on those decisions is a key driver to improving care and reducing costs.
Five articles from this issue are available online at no charge through CHCF:
“Engaged Patients Will Need Comparative Physician-Level Quality Data and Information About Their Out-of-Pocket Costs,” by Jill Mathews Yegian, Pamela Dardess, Maribeth Shannon, and Kristin L. Carman, identifies several hurdles to realizing the kind of comprehensive public reporting and value-based decisionmaking that epitomize engaged patients. The authors go on to contrast two potential solutions for delivering consumer-oriented quality and cost information: transparency for the greater good and one-stop shopping.
“Engaging Patients and Their Loved Ones in the Ultimate Conversation,” by Maureen Bisognano and Ellen Goodman, describes the Conversation Project, a grassroots public-engagement campaign designed to change the way the nation grapples with end-of-life care. The article also debuts a collaboration with the Institute for Healthcare Improvement (IHI) that will coach health care organizations on how to develop a culture of shared decisionmaking around end-of-life care.
“Patients with Lower Activation Associated with Higher Costs; Delivery Systems Should Know Their Patients’ ‘Scores,'” by Judith Hibbard, Jessica Greene, and Valerie Overton, finds that activated patients have lower overall care costs and that patient activation was a significant predictor of cost even after the population adjustment for a common “risk score” specifically designed to predict future costs.
“Group Health’s Participation in a Shared Decision-Making Demonstration Yielded Lessons, Such as Role of Culture Change,” by Jaime King and Benjamin Moulton, focuses on how one hospital began using decision aids to address deficiencies in the informed-consent process. The article highlights five key lessons about leadership, culture, and variation that are relevant to other institutions interested in integrating shared decisionmaking into clinical practice.
“Choice Architecture Is a Better Strategy Than Engaging Patients to Spur Behavior Change,” by Robert F. Nease, Sharon Glave Frazee, Larry Zarin, and Steven B. Miller, reminds readers that many healthful changes such as weight loss, better nutrition, increased exercise, and smoking cessation require long-term maintenance. Faced with this reality, the authors share their experience in applying choice architecture interventions to pharmacy-related behavior and suggest that influencing one-time decisions may be more realistic and effective than trying to engage patients.
The five articles are available free of charge on the Health Affairs site through the External Links below.