Patient engagement is a widely used buzzword throughout the healthcare industry, but for too long has been only that – a phrase with little tangible definition.
But coming to an industry-wide consensus on the meaning and scope of patient engagement can help guide future efforts to improve care, argues a new study funded by the Agency for Healthcare Research and Quality (AHRQ).
The use of the term “patient engagement” nearly tripled between 2010 and 2013 in the Web of Science, the researchers said, likely due to regulatory requirements for patient engagement technology and evidence-based claims that more engagement delivers better healthcare outcomes.
The indiscriminate use of the term “patient engagement” has affected a number of patient-centered initiatives, potentially making those programs too vague to be meaningful or effective.
“The concept has been referenced in literature published on patient-centered medical homes, comparative effectiveness research, use of technology for inpatient settings, ambulatory chronic care management, patient safety for prevention of adverse events and controlling healthcare costs,” the researchers said. “Definitions of patient engagement have varied over time and across contexts, however, rendering the essential nature of the concept elusive.”
This emphasis on patient engagement highlights a need for a standard definition, helping clinicians, researchers, and policymakers better shape initiatives for more patient-centered care.
Researchers from the Columbia University School of Nursing and Mailman School of Public Health conducted a literature review of 202 resources to identify various uses of patient engagement and analyze the context in which the term was used.
Ultimately, that analysis yielded a comprehensive definition for patient engagement.
“The concept of patient engagement can be defined as the desire and capability to actively choose to participate in care in a way uniquely appropriate to the individual in cooperation with a healthcare provider or institution for the purposes of maximizing outcomes or experiences of care,” they reported.
The researchers developed this definition by identifying common themes and attributes, subjects connected to patient engagement, and the outcomes of patient engagement.
The literature review revealed three different attributes of patient engagement, which include the process, or steps taken by patient and provider to improve engagement, behavior, or way in which these players interacted, and environment, or the tools or facility involved in the care encounter.
From those attributes, the researchers gleaned four common themes: personalization, access to necessary resources, commitment to delivering quality care, and building a positive patient-provider relationship.
“To maximize the potential for patient engagement, the attributes indicate that the process must be personalized, the patient must have access to information and resources, behavior change strategy should be applied appropriately, and a supportive relationship must exist between patients, providers, caregivers and healthcare institutions that serves to evaluate healthcare options collaboratively and sustain a partnership towards shared goals,” the researchers said.
The researchers also found that the literature more frequently mentioned patient engagement when discussing chronic disease management tactics rather than strategies for acute care or primary care for healthy patients.
Additionally, patient engagement literature most frequently discussed fragmented care coordination, appointment scheduling and care access, driving patient-provider communication, improving technology procedures, and fulfilling policy requirements, such as meaningful use or the Quality Payment Program.
With regard to the outcomes of patient engagement, the researchers identified two separate categories: improved outcomes measures and improved patient satisfaction or experience. Outcomes measures included improved patient safety, reduced costs, care coordination, and development of best practices.
Experience of care consequences included patient understanding of concepts, better communication, and job satisfaction on the part of providers practicing patient engagement strategies.
Although the team did produce a single, tangible definition for patient engagement, they conceded that the concept is dynamic and filled with nuance that affects how providers practice engagement in their own workflows.
“The large number of attributes assigned to each of the three domains (processes, behaviors, environment) suggests that the concept of patient engagement touches upon myriad dimensions of healthcare delivery,” the researchers explained.
Additionally, various different players in the healthcare space are concerned with patient engagement, including clinicians, public health experts, and patient advocates, to name a few. The many different healthcare professionals, with their complex and unique goals, may use patient engagement in different ways, thus offering another layer of nuance.
And as providers continue to look toward new and innovative avenues for patient engagement, including digital health, it will be important for industry experts to continue to assess the meaning of the concept.
“The theory, policy and practice behind implementing patient engagement in a patient-centered healthcare system merits further attention, especially in light of the increasing reliance on health information technology as an adjunct to care,” the researchers said.
However, offering at least a starting point for defining and understanding patient engagement can have a positive effect on clinician practices as well as regulatory requirements, the researchers concluded.