Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.
Health Expect. 2019 Jun;22(3):348-363. doi: 10.1111/hex.12855. Epub 2018 Dec 5.
The published literature demands examples of health-care systems designed with the active engagement of patients to explore the application of this complex phenomenon in practice.
This case study explored how the voice of patients was incorporated into the process of redesigning an element of the health-care system, a centralized system for intake of referrals from primary care to rheumatologists for patients with suspected rheumatoid arthritis (RA)-centralized intake. The phenomenon of patient engagement using "patient and community engagement researchers" (PaCERs) in research and the process of redesigning centralized intake were selected as the case. In-depth evaluation of the case was undertaken through the triangulation of findings from the document review and participants' reflection on the case.
In this case, patients and PaCERs participated in multiple activities including an initial meeting of key stakeholders to develop the project vision; a patient-to-patient PaCERs study to gather perspectives of patients with RA on the challenges they face in accessing and navigating the health-care system, and what they see as key elements of an effective system that would be responsive to their needs; the development of an evaluation framework for future centralized intake; and the choice of candidate centralized intake strategies to be evaluated.
The described feasible multistep approach to active patient engagement in health-care system redesign contributes to an understanding of the application of this complex phenomenon in practice. Therefore, the manuscript serves as one more step towards a patient-centred health-care system that is redesigned with active patient engagement.
已发表的文献需要有患者积极参与设计的医疗保健系统的实例，以探索这一复杂现象在实践中的应用。
本案例研究探讨了如何将患者的声音纳入医疗保健系统设计的一个元素的过程，即针对疑似类风湿关节炎（RA）患者的从初级保健到风湿病学家转诊的集中式系统——集中式入组。选择使用“患者和社区参与研究人员”（PaCERs）进行研究和重新设计集中式入组的过程中的患者参与现象作为案例。通过对文献回顾和参与者对案例的反思的研究结果进行三角分析，对案例进行了深入评估。
在这个案例中，患者和 PaCERs 参与了多项活动，包括：召开主要利益攸关方会议，制定项目愿景；开展 PaCERs 患者对患者研究，收集 RA 患者在获取和使用医疗保健系统方面面临的挑战的观点，以及他们认为有效的系统的关键要素是什么，该系统将对他们的需求做出响应；制定未来集中式入组的评估框架；选择候选集中式入组策略进行评估。
所描述的积极参与医疗保健系统重新设计的多步骤可行方法有助于理解这一复杂现象在实践中的应用。因此，本文为以患者为中心的医疗保健系统的重新设计提供了更多的实践经验，其中积极参与了患者。
