Promoting Patient Engagement in an Era of System Transformation Carolyn M. Clancy, M.D. Director Agency for Healthcare Research and Quality IOM Evidence Communication Innovation Collaborative October 28, 2011
The Evolving Doctor-Patient Relationship This era is ending, being replaced with consumerism and the movement toward shared decision making Teutsch, C. Patient doctor communication. The Medical Clinics of North America 2003;87:11-15-45. Previous research has demonstrated a strong relationship between patient-centered patterns of communication and higher levels of satisfaction and trust Jackson JL. Communication about symptoms in primary care: impact on patient outcomes. The Journal of Alternative and Complementary Medicine 2005;11(Supplement 1):S-51 S-56. There is a 19 percent higher risk of non-adherence among patients whose physician communicates poorly than among patients whose physician communicates well Haskard Zolnierek KB, DiMatteo MR. Physician communication and patient adherence to treatment: a meta-analysis. Medical Care 2009 August;47(8):826-34.
Promoting Patient Engagement in an Era of System Transformation Putting the Patient at the Center of Care Promoting/Encouraging Patient Engagement Activities in 2011 and Beyond Q & A
Patient Engagement History To Err is Human: Building A Safer Health System AHRQ initiates 5-year, $150M in patient safety funding AHRQ/Ad Council exploratory research finds patients worry about errors, but don t feel empowered to take action Doing What Counts for Patient Safety: Federal Actions to Reduce Medical Errors Harvard/Kaiser surveys find 42% of public and 35% of physicians report experiencing errors Questions are the Answer Campaign First TV ads feature singing/dancing health care professionals
Inaugural Questions are the Answer Campaign Raise awareness among patients that asking questions can lead to better health care outcomes Drive consumers to ahrq.gov/questions web site for information
2009 Update: Questions are the Answer Campaign Focus groups indicate that patients think they are asking questions, but don t know the right ones to ask New ads ( restaurant and cell phone store ), and interactive Question Builder allow patients to create customized lists of evidence-based questions for medical appointments
2011 Preguntas Campaign: AHRQ and the Ad Council A new, multimedia Spanish-language campaign Features television, radio, print and Web ads Supports HHS plan to reduce health disparities among racial and ethnic minorities www.ahrq.gov/preguntas
The Evolving Doctor-Patient Relationship: 2011 Randomized controlled trial finds individual (IE) education works better than group education for patients with type 2 diabetes IE also led to a trend toward better social and psychological behavioral outcomes Few inclusion/exclusion criteria were applied and interventions were tested in real-world settings Sperl-Hillen J, Beaton S. Comparative Effectiveness of Patient Education Methods for Type 2 Diabetes. Archives of Internal medicine, October 10, 2011
Questions are the Answer: 2011 New ads running this fall in medical journals, including NEJM, JAMA, American Family Physician, Annals of Internal Medicine, Journal of the American Academy of Physician Assistants, Journal for Nurse Practitioners, etc Focus group feedback from patients indicates that they feel physicians are rushed and don t have time for questions Primary care physicians and nurses say patients need to prioritize questions (no time to go over every study found on the internet)
Added Focus on Prioritizing Web site updated to include videos featuring patients and clinicians Products include: Web site expansion Brochure Waiting room video Notepads with room to write top three questions Tips for before, during and after appointments
From the Engaged Patient s Perspective Bill Lee After 10 heart attacks, Bill got more involved in his care. Now his heart disease and diabetes are under control. http://www.ahrq.gov/questions/pcvideos.htm
The Engaged Clinician Linda Bradley- Tiernan, M.D. This heart doctor brings her list of questions when she visits her doctor and says you should, too. http://www.ahrq.gov/questions/pcvideos.htm
Questions are the Answer: Response Coverage by major media, including the Wall Street Journal, New York Times, and National Public Radio More than 1 million web hits since its inception, far outpacing any of the other AHRQ patient engagement campaigns to date The 2011 Campaign generated more than 52,863 hits from September 19-28
Patient Engagement is a Team Sport Collaboration is Key Ongoing outreach to medical groups, health clinics and waiting room settings Strong partnerships with national, state and local organizations Networks dedicated to putting the patient at the center of care Consumer and community involvement
Future Priorities for Evidence Communication Expand the knowledge base on how people put evidence into practice in their everyday lives Further examination of the different stages of receptiveness to engagement and how they can be addressed Address the gaps that exist between our ability to produce data and having the capacity to produce actionable information that can be used right now Promote value by making the most of opportunities emerging with the momentum that has been generated for system transformation
Thank You AHRQ Mission To improve the quality, safety, efficiency, and effectiveness of health care for all Americans AHRQ Vision As a result of AHRQ's efforts, American health care will provide services of the highest quality, with the best possible outcomes, at the lowest cost www.ahrq.gov