Analysis of the second NEJM Catalyst Insights Council Survey on the Patient Engagement theme. Qualified executives, clinical leaders, and clinicians may join the Insights Council and share their perspectives on health care delivery transformation.
The foundation has been laid for exciting advances in patient engagement, according to the second NEJM Catalyst Patient Engagement Survey. With fundamental patient engagement strategies such as patient portals and secure email firmly in place, health care organizations are now turning to Patient Engagement 2.0 — initiatives that will get patients even more involved in their care.
The survey was fielded to gauge participation in, and effectiveness of, patient engagement across health systems, hospitals, and physician organizations. More than 69% of respondents report that their organizations use patient engagement initiatives to increase patients’ meaningful participation in care.
This percentage presents somewhat of a Rorschach test, however. Ideally, as health care providers head toward more widespread value-based care, the number using patient engagement initiatives should be far closer to 100%. As an industry, we obviously have more work to do to demonstrate that providers should be engaging and supporting patients outside of direct health care encounters.
Consider the 5,000-hour problem. In the 2012 New England Journal of Medicine article, “Automated Hovering in Health Care — Watching Over the 5000 Hours,” we noted that although patients spend only a few hours a year with a doctor or nurse, they spend 5,000 waking hours each year engaged in everything else, including deciding whether to take prescribed medications, choosing what to eat and drink and whether to smoke, and making other choices about activities that can profoundly affect their health.
How do clinicians make a dent in prevention if you have only a few hours in front of a patient? Many survey respondents comment that we need to engage patients outside the exam room with frequent, creative interactions that do not have to always include their physicians.
Much Room to Improve Patient Engagement
Nearly half of respondents to the NEJM Catalyst Patient Engagement Survey say their patient engagement initiatives are having a major (14%) to moderate (34%) impact on quality outcomes. That’s pretty remarkable considering we are still in the earlier stages of patient engagement and that many potential approaches have yet to be fully scaled and integrated into practice. Interestingly, clinical leaders (60%) feel more strongly than executives (47%) and clinicians (43%) that their efforts to engage patients are working.
More than a third of respondents say portals are the most effective form of patient engagement. Secure email is a distant second at 14%.
Survey respondents clearly think the best is yet to come — Patient Engagement 2.0.
For instance, while 68% say they are currently using or have plans to implement patient-generated data, only 34% are currently using it at scale, leaving 13% in pilot stages and 22% planning for it in the next 24 months. Patient-generated data is health-related data created, recorded, or gathered by or from patients (or family members or other caregivers) to help address a health concern. For instance, patients could share the results of their blood glucose monitoring, blood pressure readings, or exercise programs.
VERBATIM COMMENTS FROM SURVEY RESPONDENTS
What is the most creative way you know of to enhance patient engagement?
“Promote clinician wellness, prevent burnout, and avoid grumpy bosses who make you feel like your job is in jeopardy.”
“Nursing care conferences with patient, family, and multidisciplinary team, plus PCP.”
“Look them in the eye and not have a computer in the room.”
“Using multiple avenues of approach to patients and home caregivers to enable them to provide enhanced self-care.”
“It’s not creative, but simply having the provider call [the] patient and discuss health issues.”
“Patient engagement is enhanced most effectively by attentively listening and constantly adapting to each individual’s needs, expectations, and abilities. I am a big proponent of advanced technology, however, no fancy electronic tool or gimmicky wearable wireless device will ever be able to increase patient engagement to the same degree as developing a solid physician-patient relationship.”
“Deploying the full spectrum of communication: patient education prior to discharge, follow-up phone calls after discharge, follow-up email with health and wellness tips related to the patients’ specific conditions.”
“Intensive education of a patient on Etiology of their disease, Effectiveness of latest care, Efficiency with comparative affordability of the care, and parameters of Quality-of-Life outcome prognosis SHOULD ALWAYS BE PRESENTED at the First Encounter with a Physician and/or Surgeon. This paradigm has worked for me in the past 36 years of med-surg practice.”
“Quantifying their life — sleep tracker, calorie tracker, step and exercise logging, symptom diary. If this could be integrated into an EHR and updated from a mobile device, that would be amazing.”
“Open, honest, respectful conversation and being fully present with all encounters.”
“Multidisciplinary team rounds. The patients hear the plan for the day, have the opportunity to ask questions, and know that all members of the team are communicating. Patient family members know when rounds begin, and are often present as well.”
Likewise, social networks are only 31% at scale today, with 26% in pilot or planning stages, according to the survey. Social networks use the patient’s support network, including family and community, to create positive, sustained behaviors. For instance, a provider could offer family cooking classes to influence better nutrition for diabetic patients.
Wireless/wearable devices (such as heart rate monitors or activity trackers) are used at scale by only 16% of respondents, but 31% say they are in pilot or planning phases. The proliferation of these technologies should result in greater competition and lower cost from vendors.
However, provider organizations must make significant strides in assimilating the large amounts of data generated by these devices into clinicians’ daily workflow.
Benefit design, which 17% of respondents are using at scale as a tool for patient engagement, is listed by 21% as in pilot or planning stages. Providers plan to restructure patient benefits to align with intended behaviors, such as decreasing required co-pays for smoking cessation classes or insulin education visits for diabetics. Co-pays traditionally are meant to deter overutilization, but providers must align their patients’ best interests — for example, getting diabetes under control — with the design of benefits.
These anticipated initiatives could help boost the cost impact of patient engagement as well. Fewer than 10% of survey respondents say their current patient engagement initiatives have a major impact on cost, and fewer than 20% note a moderate impact. With the shift to value-based payment models, there may be more of an imperative to design and test new ideas to engage patients between visits that will improve both cost and quality.
As further proof of the need to engage patients between visits, 90% of respondents say care coordinators are essential (36%), very important (30%), or important (24%) in improving patient engagement. Care coordinators seem to be the litmus test for organizations to prove they are serious about patient engagement. Respondents are less bullish about a patient advocacy structure such as Patient and Family Advisory Councils, with less than a fifth calling it essential.
Who Will Lead Patient Engagement?
So who will lead the charge to Patient Engagement 2.0? According to our survey, it depends on whom you ask. Executives and clinical leaders say the Chief Medical Officer is best equipped to head up this challenge, while clinicians say staff physicians should take the helm. Overall, CMOs ranked highest at 38%, followed by staff physicians (35%) and staff nurses (23%).
No matter who takes on the responsibility of getting to the next level of patient engagement, they must be innovative enough to strengthen the foundational elements and to build the next wave of initiatives that will improve outcomes and experience for our patients.
METHODOLOGY AND RESPONDENTS
In July 2016, an online survey was sent to the NEJM Catalyst Insights Council, which includes U.S. health care executives, clinician leaders, and clinicians at organizations directly involved in health care delivery. A total of 369 completed surveys are included in the analysis. The margin of error for a base of 369 is +/- 5.1% at the 95% confidence interval.
The majority of respondents were clinicians (53%), with executives (22%) and clinician leaders (25%) nearly evenly split. Most respondents described their organizations as hospitals (40%) or health systems (15%). These hospitals were predominantly midsized (33% had 200–499 beds) or larger (47% had 500 or more beds).
Only 9% of respondents indicated that their major affiliation was with a physician organization. Those physician organizations tended to be big — 47% had 100 or more physicians.
More than two-thirds of the organizations (68%) were nonprofit, with the remainder of respondents coming from for-profit organizations. Every region of the country was well represented.
Join the NEJM Catalyst Insights Council and contribute to the conversation about health care delivery transformation. Qualified members participate in brief monthly surveys.