Wednesday, February 13, 2013

Studies Explore Patient Engagement

The February issue of “Health Affairs” explores the burgeoning field of activating and engaging patients in their health and healthcare. Studies show that more informed and empowered patients have better outcomes and there is some evidence that they also have lower healthcare costs. A briefing titled “New Era of Patient Engagement” held February 6th in Washington D.C, presented a series of six panels moderated by Susan Dentzer, Editor-in-Chief for Health Affairs.

The February issue was supported by the Robert Wood Johnson Foundation, the Gordon and Betty Moore Foundation, the Patient-Centered Outcomes Research Institute, and the California HealthCare Foundation.

One of the studies published in the February issue titled “What the Evidence Shows about Patient Activation: Better Health Outcomes and Care Experiences” by Judith Hibbard PhD, Professor Emeritus at the University of Oregon and her coauthors found an interesting statistic. The research found that individuals lacking in the skills and confidence to be actively engaged in their healthcare had average costs that were 8 percent to 21 percent higher as compared to patients with the highest level of activation.

In another study “HealthPartners’ Online Clinic for Simple Conditions Delivers Savings” conducted by Patrick Courneya of HealthPartners in Minneapolis reported that the HealthPartners’ online clinic called “virtuwell” launched in 2010, provides online access 24/7 to treatment by nurse practitioners for 40 simple conditions.

The author notes that “virtuwell” is the first online service to be authorized for coverage under Medicare. After 40,000 cases where patients used online care, the company saw savings of $88 per episode over care in traditional settings, the care was clinically effective, and 98 percent of patients were willing to recommend the service.

Jonathan B Perlin, MD, PhD, President, Clinical and Physicians Services Group, and Chief Medical Officer at the Hospital Corporation of America, a panelist at the briefing, discussed some of the ideas that  leading organizations have initiated.

  • Kaiser Permanente—(Health Bones Program) developed measures to identify and proactively treat patients at risk for osteoporosis and hip fractures. Used standardized practice guidelines for osteoporosis management, plus education, and home health programs. Over five years, there was a 30 percent reduction in hip fracture rates for at-risk patients

  • Virginia Mason Health System—(Reduced Workflow Inefficiencies Through Rapid Process Improvement) set up nursing teams to work with patient care technicians in cells (groups of rooms located near each other) rather than spread across a unit. The result is that nurses spent 99 percent of their time on direct patient care as compared to 35 percent previously which resulted in an 18 percent improvement in timeliness of care

  • Cincinnati Children’s Hospital Medical Center—(Patient Flow Improvement) implemented a series of operations management interventions to improve patient flow through the ICU. As a result, there are fewer delays and cancellations of elective surgeries due to unavailable beds, more predictable flow of patients, the need for 75 new beds has been eliminated, and $100 million has been saved in capital costs

  • The Cleveland Clinic—(Care Enhancement Program for Lung Transplant Patients) engaged patients through daily huddles with caregivers to help understand the patient’s prognosis and to create a shared care plan. The total length of stay was reduced by 1.54 days, costs of care decreased by 6 percent, patient satisfaction improved by 28 percent, and 30 day survival improved by 3 percent

The application of strategies to empower patients, improve outcomes, and lower costs is important, and as a result, research in this field is being pursued. The Patient-Centered Outcomes Research Institute (PCORI) as authorized by ACA, funds research to assist patients, caregivers, clinicians, payers, and policy makers on how to make informed health decisions.

Joe Selby Executive Director for PCORI pointed out that PCORI has joined with several federal agencies such as AHRQ, NIH, and FDA to begin to involve patients and stakeholders in a meaningful way to generate and review research questions.

Last December, PCORI issued a broad funding announcement and announced their first 25 awards for a total of $40.7 over three years. The projects range from studying ways to care for people with cardiovascular disease and stroke, studying certain cancers, chronic kidney disease, chronic pain, depression, and pediatric diabetes as well as caring for people with multiple conditions.

Health Affairs is published by Project HOPE. Additional web first papers are published periodically and health policy briefs published twice monthly, The Health Affairs journal can be found on Facebook and Twitter.

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