Keddem Shimrit, Agha Aneeza Z, Long Judith A, Werner Rachel M, Shea Judy A
*Veterans Integrated Service Network 4, Center for Evaluation of PACT (CEPACT) †Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania ‡Corporal Michael J. Crescenz VA Medical Center, VA Center for Health Equity Research and Promotion (CHERP), Philadelphia, PA.
Med Care. 2017 Sep;55 Suppl 9 Suppl 2:S59-S69. doi: 10.1097/MLR.0000000000000748.
Patient engagement has become a major focus of health care improvement efforts nationally. Although evidence suggests patient engagement can be beneficial to patients, it has not been consistently defined, operationalized, or translated into practice.
Our objective was to develop a toolkit to help providers increase patient engagement and reduce disparities in patient engagement.
We used qualitative interviews and observations with staff at primary care sites nationally to identify patient engagement practices and resources used to engage patients. We then used a modified Delphi process, that included a series of conference calls and surveys, where stakeholders reduced lists of engagement practices based on perceived feasibility and importance to develop a toolkit for patient engagement.
Sites were selected for interviews and site visits based on the concentration of minority patients served and performance on a measure of patient engagement, with the goal of highlighting practices at sites that successfully serve minority patients.
We created a toolkit consisting of patient engagement practices and resources. No identified practice or resource specifically targeted patient engagement of minorities or addressed disparities. However, high-performing, high-minority-serving sites tended to describe more staff training opportunities and staff feedback mechanisms. In addition, low-performing and high-minority-serving sites more often reported barriers to implementation of patient engagement practices.
Stakeholders agreed on feasible and important engagement practices. Implementation of this toolkit will be tracked to better understand patient engagement and its effect on patient-centered care and related disparities in care.
患者参与已成为全国医疗保健改善工作的主要重点。尽管有证据表明患者参与对患者有益，但它尚未得到一致的定义、实施或转化为实践。
我们的目标是开发一个工具包，以帮助医疗服务提供者提高患者参与度并减少患者参与度方面的差异。
我们对全国基层医疗场所的工作人员进行了定性访谈和观察，以确定患者参与实践以及用于促进患者参与的资源。然后，我们采用了改良的德尔菲法，包括一系列电话会议和调查，利益相关者根据感知到的可行性和重要性减少了参与实践列表，以开发一个患者参与工具包。
根据所服务的少数族裔患者的集中程度以及患者参与度指标的表现来选择进行访谈和实地考察的场所，目的是突出成功服务少数族裔患者的场所的实践。
我们创建了一个由患者参与实践和资源组成的工具包。没有发现任何特定针对少数族裔患者参与或解决差异问题的实践或资源。然而，表现出色、服务少数族裔比例高的场所往往描述了更多的员工培训机会和员工反馈机制。此外，表现不佳且服务少数族裔比例高的场所更常报告患者参与实践实施的障碍。
利益相关者就可行且重要的参与实践达成了一致。将对该工具包的实施进行跟踪，以更好地了解患者参与及其对以患者为中心的护理和相关护理差异的影响。
