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Wednesday Dec 03, 2014

Getting Engaged: Patient Input Can Spark Improvement

There is a lot of talk these days about partnering with patients -- not just during their office visit, but truly making them the center of their own care team. In fact, this is one of the main themes of the patient-centered medical home.  

When patients are engaged in their care, patient satisfaction improves, care quality and safety are enhanced, and efficiency is heightened. In a nutshell, actively involving and engaging patients in their care helps us achieve the triple aim of improving health, improving the patient experience and reducing costs.

It seems like a given that patients should be central to their own care, but in reality, care often is given to -- rather than coordinated with -- patients.  

I recently served on a panel that discussed patient engagement during the fall conference(archive.pcpcc.net) of the Patient-Centered Primary Care Collaborative (PCPCC). We heard from organizations that have included patients on a variety of levels, from serving on focus groups to helping with clinic redesign. One clinic included patients in the process of developing their care management workflows, starting with information-gathering and continuing to use patients' input for plan development and delivery.  

These examples really showed that when patients were involved, not only did patient outcomes improve, but the providers came to better understand how to deliver care. However, these were large, university-funded practices with the ability to appoint patient advocates and teams to monitor patient engagement. Many of our small practices can't afford to do those things, but that doesn't mean we can't benefit from patient feedback.

At my integrative primary care practice, the patient experience has been at the core of our mission since we opened last year. It is important to get patient input, and in the year-and-a-half that we have been open, we have used two patient satisfaction measurement tools. The first was an ongoing patient feedback form that was given to patients at check-out after every visit for several months. The second was a survey instrument that was e-mailed to all patients who had been seen in the previous six months. The survey allowed patients to comment on how we were doing both individually and collectively. They could celebrate our accomplishments and voice their concerns. We received a lot of valuable feedback that will help us as we grow and move forward.  

For example, one of the concerns we heard was that our new patient intake and history form was too long. We revised the form, drawing on sample forms and examples of best practices. We tried to take ourselves out of our role as health care professionals and put ourselves in the patients' shoes. We developed a form that we thought balanced the information that we needed to collect with the brevity they desired.

But before we released the new form, we decided to take it one step further and actually ask our patients what they thought. We convened a diverse group of our patients and asked them to come in one evening to review the forms. They were compensated with dinner and a gift certificate for a class in our wellness center. What we learned was invaluable, and as much as we had tried to put ourselves in our patients' position, we realized we hadn't done a good job of it. With their feedback, we were able to further streamline the form, add questions that addressed their concerns, and we got additional suggestions on how to use technology to assist in the process.

The process isn't yet complete, and we are taking their suggestions forward as we implement our new electronic health records system. But what's most important is that we have established a system of patients as partners who are invested in their own care and the care of everyone else who walks through our doors. That is true patient engagement.

Kisha Davis, M.D., M.P.H., is medical director of an integrative primary care practice in Gaithersburg, Md.

Posted at 10:00AM Dec 03, 2014 by Kisha Davis, M.D.

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