Highly activated patients take proactive, collaborative roles in maintaining their health. They are more likely to engage in healthy and preventive behaviors than their less activated counterparts, and incur lower health care costs. Higher activation often corresponds with improved health outcomes and greater patient satisfaction. However, increasing patient activation can be difficult, especially when patients face such additional challenges as low literacy, language and cultural barriers, and physical disabilities.
Patient activation is a fundamental component of the Patient-Centered Medical Home (PCMH), a care model that increases patient engagement with a team of health care providers through coordinated care and the use of technology. A clinical education and research project team led by Adina Kalet, MD, MPH at the NYU School of Medicine, Division of General Internal Medicine, part of the NYU Langone Medical Center (NYU Langone) is developing and testing an innovative Patient Empowerment Program (PEP) within NYU’s PCMH and linking it to the training of primary care residents. This work was supported by a Clinical Care Innovation Challenge Award from the Association of American Medical Colleges.
Increasing Patient Engagement
Especially for patients with chronic conditions, increasing engagement with the health care team so that their needs, values, and preferences are respected and they have input in their care is vital. But how do patients learn to be equal partners in their care? The NYU Langone team is tackling this challenge head-on with PEP to benefit not only the patients they serve, but to spread and support health systems redesign and provider training in the long term.
Rather than utilizing standardized patients as in other simulation approaches, the NYU Langone program works with actual patients from its PCMH, which allows for direct feedback and impact for both patient and learner. Patients with type 2 diabetes were recruited from the NYU Langone PCMH to participate in a series of PEP sessions to demystify the medical encounter and learn the skills to be active participants in their care. Medical students and residents participate in the sessions and focus groups to assess the barriers to patient activation and from there develop a set of training materials to be disseminated broadly. Although they’re working with real patients, the PEP sessions and focus groups utilize elements of standardized patient training, a well-established, performance-based intervention that uses actors in the education of physician trainees.
The NYU Langone research team is making progress with their PEP work. Thus far, they have engaged 80 adult diabetic patients in a series of focus groups with the trainees and providers. A significant ‘aha moment’ comes when trainees see patients benefiting from being more activate in their own care. ”While many schools use trained standardized patients who play the role of a person with a given condition or symptoms, we are with actual diabetic patients who have very real concerns about their health. Many start out feeling vulnerable and disempowered. As the students and residents hear how the patients are feeling and what is most important to them, we are honing our communication skills and learning to engage in shared-decision making. The patients are more activated. It’s a win–win,” says Joseph Plaksin, a dual-degree, fifth-year student who has been facilitating PEP focus groups.
Evidence of Change
When actual patients participate with the trainees and the health care team, there is evidence of behavior change for each of them. Patients have lost weight, some stop smoking, while others take the critical step of completing their health proxy and living will forms. Trainees have more empathy for patients and think about how to be more sensitive in other clinical scenarios they face.
The lessons learned from this project will contribute to the development of educational and training materials for patients, students, and residents, as well as a protocol for a PCMH program based at Bellevue Hospital Center, which serves a diverse and medically underserved population and is a primary teaching site for the NYU School of Medicine residency training program.
The NYU Langone team is also looking at the long-term impact of this program, including systems-based reductions in health care costs and more efficient care. A recent study demonstrated that when patients’ activation in their own health care increases, health outcomes improve and costs are reduced, even several years later. Project lead Adina Kalet, MD, MPH says, “For our population of diabetic patients, we anticipate an increase in adherence to medical advice, fewer hospital admissions, fewer missed appointments, and an overall reduction in high-cost outcomes. In the short term, we will be looking at measurable changes in the patients’ hemoglobin A1c levels and anticipate there will be decreases.”
Adina Kalet, MD, MPH was a recipient of the 2014 Association of American Medical Colleges Clinical Care Innovation Challenge Award. If you are interested in obtaining more information about this project or another CCIC project, please email firstname.lastname@example.org. The 2016 Clinical Care Innovation Challenge Awards application period is currently open and accepting applications.