Chen Jie, Mullins C Daniel, Novak Priscilla, Thomas Stephen B
University of Maryland, Baltimore, MD, USA
University of Maryland, Baltimore, MD, USA.
Health Educ Behav. 2016 Feb;43(1):25-34. doi: 10.1177/1090198115579415. Epub 2015 Apr 6.
Designing culturally sensitive personalized interventions is essential to sustain patients' involvement in their treatment and encourage patients to take an active role in their own health and health care. We consider patient activation and empowerment as a cyclical process defined through patient accumulation of knowledge, confidence, and self-determination for their own health and health care. We propose a patient-centered, multilevel activation and empowerment framework (individual-, health care professional-, community-, and health care delivery system-level) to inform the development of culturally informed personalized patient activation and empowerment (P-PAE) interventions to improve population health and reduce racial and ethnic disparities. We discuss relevant Affordable Care Act payment and delivery policy reforms and how they affect patient activation and empowerment. Such policies include Accountable Care Organizations and value-based purchasing, patient-centered medical homes, and the community health benefit. Challenges and possible solutions to implementing the P-PAE are discussed. Comprehensive and longitudinal data sets with consistent P-PAE measures are needed to conduct comparative effectiveness analyses to evaluate the optimal P-PAE model. We believe the P-PAE model is timely and sustainable and will be critical to engaging patients in their treatment, developing patients' abilities to manage their health, helping patients express concerns and preferences regarding treatment, empowering patients to ask questions about treatment options, and building up strategic patient-provider partnerships through shared decision making.
设计具有文化敏感性的个性化干预措施对于维持患者参与治疗并鼓励患者在自身健康及医疗保健中发挥积极作用至关重要。我们将患者激活和赋权视为一个循环过程，其定义为患者积累有关自身健康及医疗保健的知识、信心和自我决定权。我们提出一个以患者为中心的多层次激活和赋权框架（个体、医疗保健专业人员、社区及医疗保健提供系统层面），以为文化上有针对性的个性化患者激活和赋权（P-PAE）干预措施的开发提供参考，从而改善人群健康状况并减少种族和族裔差异。我们讨论了《平价医疗法案》相关的支付和服务政策改革及其对患者激活和赋权的影响。此类政策包括 accountable Care Organizations 和基于价值的采购、以患者为中心的医疗之家以及社区健康福利。还讨论了实施 P-PAE 所面临的挑战及可能的解决方案。需要具备一致的 P-PAE 衡量标准的综合纵向数据集来进行比较效果分析，以评估最佳的 P-PAE 模型。我们认为 P-PAE 模型适时且可持续，对于促使患者参与治疗、培养患者管理自身健康的能力、帮助患者表达对治疗的担忧和偏好、使患者有能力就治疗选择提出问题以及通过共同决策建立战略性患者 - 提供者伙伴关系至关重要。
