Director's Corner: What’s the Latest Evidence on Patient Engagement by Primary Care Practices?

Here at the Center for Consumer Engagement in Health Innovation, we hold the core belief that the voices of consumers are essential for making our health care system better: easier to navigate, more user-friendly and more effective at addressing the things that matter to patients, families and caregivers, and communities. We work toward increasing the engagement of consumers at three levels: in the clinical setting; at the level of the health care organization or practice; and in health care policy-making.

While there is a robust and growing body of research that examines how and why to engage consumers in the clinical setting (first level), there has to date been less evidence examining the engagement of consumers at the other two levels.

This is why I was delighted to find several articles published over the past year that examine the engagement of consumers at the organization/practice level. Here are my brief notes from four papers in this sphere that I found valuable:

In “Engaging patients in primary care practice transformation: theory, evidence and practice,” published in Family Practice in 2016, authors Anjana Sharma and Kevin Grumbach review the evidence for the efficacy of patient engagement in primary care practice, at the clinic or practice level. They retrace the history of patient engagement, noting the establishment of federally funded community health centers in the 1960s, with the requirement that health center patients must comprise at least 51 percent of a center’s community advisory board. They summarize the conclusions of systematic reviews published since 2000 on the effects of patient engagement at the practice level and note some promising findings related to improved workflow, access and understandable patient information. Finally, they identify strategies for promoting patient engagement at the practice level, including things such as patient surveys, town halls and patient advisory councils, summarizing the advantages and limitations of each.

Dr. Sharma is also the lead author on another 2016 paper focusing on patient advisory councils, published in the Journal of the American Board of Family Medicine. The paper takes its title from a question posed by one of the study participants: “How can we talk about patient-centered care without patients at the table? Lessons learned from Patient Advisory Councils.” The authors identified nine primary care clinics in Northern California with high-functioning patient advisory councils and interviewed one clinic staff member and one patient member of the advisory council at each site. The interviews reinforced the importance of recruitment and training of patients, as well as of support for the training of staff facilitators. They note that training of consumers likely will be particularly important to increase the diversity of advisory council representation to include patients from hard-to-reach populations, an area of active work for us here at the Center.

A multilevel analysis of patient engagement and patient-reported outcomes in primary care practices of Accountable Care Organizations,” by Stephen Shortell and colleagues in the February issue of the Journal of General Internal Medicine analyzed patient engagement and patient-reported outcomes for patients with cardiovascular disease or diabetes in 16 primary care practices within two accountable care organizations: Advocate Health Care (AHC) in Chicago, IL and DaVita HealthCare Partners in Los Angeles, CA. The authors found that in practices that scored higher on a scale of “patient-centeredness” (made up of five questions related to how well the practice incorporates patient feedback), patients were less likely to report symptoms of depression and more likely to report better physical health outcomes. Interestingly, a 39-item scale completed by practice administrators listing various engagement activities was negatively associated with patient-reported outcomes, suggesting that the cultural dimension of patient-centeredness may be more important than simply increasing the number of engagement activities practices implement. This suggests that we need to go beyond “checking the boxes” when it comes to patient engagement activities and focus on creating a pervasively patient-centered culture of care.

Finally, I enjoyed reading about a family medicine clinic in Calgary that established a patient advisory council. “Patient and citizen innovation in family practice,” by Ron Garnett and others in Canadian Family Physician describes how the clinic recruited patients for the council. It also describes the activities completed by the advisory council to date, including delivering presentations to family medicine residents and staff on the role of the council, establishing patient liaisons to several committees and conducting a pilot patient experience survey. Future areas of interest for the advisory council include developing systems to routinely and accurately measure and enhance patient satisfaction, immersing learners in a culture of patient-engaged clinic service, and developing a mechanism for ongoing evaluation of the outcomes and effectiveness of the council’s activities. I certainly look forward to hearing more about their progress in these very important activities.

Taken together, these papers help to build out our nascent base of evidence around the “hows and whys” of patient engagement. As this field develops, I look forward to sharing many more research updates with you in the future.