From Department of Family and Community Medicine, Center for Excellence in Primary Care, University of California, San Francisco, CA (AES, MK, RW-G, KG, MBP); The American Board of Family Medicine, Lexington, KY (LEP).
J Am Board Fam Med. 2018 Sep-Oct;31(5):733-742. doi: 10.3122/jabfm.2018.05.170418.
Emerging policy consensus advocates that patient-centered care should include an active, practice-level patient role, but it is unknown how commonly these roles are implemented. We sought to understand current prevalence and predictors of practice-level patient engagement in US primary care settings.
We assessed practice-level patient engagement by using 2016 American Board of Family Medicine Certification Examination registration data, restricted to ambulatory primary care site respondents randomly selected for a patient-centered medical home (PCMH) question module. Multivariate logistic regression models identified predictors of high-intensity patient engagement, defined as a patient advisory council or patient volunteers in quality improvement activities.
A total of 6900 examinees reported practicing in primary care sites; 1368 randomly received PCMH questions. Practice-level patient engagement included patient surveys (76.5%; 95% CI, 74.3-78.8%), patient suggestion boxes (52.9%; 95% CI, 50.2-55.5%), patient board of director memberships (18.8%; 95% CI, 16.7-20.9%), patient advisory councils (23.8%; 95% CI, 21.5-26.0%), and patient participation in quality improvement (20.5%; 95% CI, 18.3-22.6%). High-intensity patient engagement was reported by 31.1% (95% CI, 28.7-33.6%); predictors included large practice size (OR, 3.30; 95% CI, 1.96-5.57), serving more vulnerable patient populations, (OR, 1.83; 95% CI, 1.18-2.84) and PCMH certification (OR, 2.19; 95% CI, 1.62-2.97).
Nearly one-third of physicians reported working in settings with high-intensity practice-level patient engagement. An implementation science approach should examine why high-intensity activities are more common in some practice settings and whether these activities add value through improved patient experience and health outcomes.
新兴政策共识主张，以患者为中心的护理应包括积极的、以实践为基础的患者角色，但目前尚不清楚这些角色的实施情况有多普遍。我们旨在了解美国初级保健环境中以实践为基础的患者参与的当前流行程度和预测因素。
我们通过使用 2016 年美国家庭医学委员会认证考试注册数据评估以实践为基础的患者参与度，这些数据仅限于选择参加以患者为中心的医疗之家（PCMH）问题模块的门诊初级保健场所的受访者。多变量逻辑回归模型确定了高强度患者参与度的预测因素，高强度患者参与度定义为患者咨询委员会或患者志愿者参与质量改进活动。
共有 6900 名考生报告在初级保健场所执业；其中 1368 人随机接受 PCMH 问题调查。以实践为基础的患者参与包括患者调查（76.5%；95%置信区间，74.3-78.8%）、患者建议箱（52.9%；95%置信区间，50.2-55.5%）、患者董事会成员（18.8%；95%置信区间，16.7-20.9%）、患者咨询委员会（23.8%；95%置信区间，21.5-26.0%）和患者参与质量改进（20.5%；95%置信区间，18.3-22.6%）。高强度患者参与度的报告率为 31.1%（95%置信区间，28.7-33.6%）；预测因素包括较大的实践规模（比值比，3.30；95%置信区间，1.96-5.57）、为更多弱势患者群体服务（比值比，1.83；95%置信区间，1.18-2.84）和 PCMH 认证（比值比，2.19；95%置信区间，1.62-2.97）。
近三分之一的医生报告称在高强度以实践为基础的患者参与度的环境中工作。实施科学方法应该研究为什么高强度活动在某些实践环境中更为普遍，以及这些活动是否通过改善患者体验和健康结果来增加价值。
