April 7, 2018
Context: The Missing Link to Patient Engagement and Better Health Outcomes
By Peggy Fischer
📷“Patient engagement” has long been cited as the “ last mile of healthcare” - that one pivotal, remaining challenge that stands between failure and success - between bad and good health outcomes, between escalating and controlled healthcare costs. It makes sense: the more people actively participate in their own care, the better the results will be.
“Providers can do a great job of using their knowledge and experience, along with evidence-based best practices, to develop a plan of care that they know will improve a patient's health,” says Lori O'Brien, MSN, RN, and senior clinical strategist at Zynx Health. “None of that will matter, however, if the patient either doesn't understand what he or she needs to do or chooses not to participate, ”¹ e.g., fails to schedule a follow-up visit, quit smoking or comply with a treatment plan.
According to clinicians, the majority of their patients are not highly engaged.
Clinicians say the majority of their patients demonstrate a lack of interest and responsibility when it comes to making choices about their care. In a survey of more than 300 clinical leaders and healthcare executives, more than 70% of the respondents reported having less than 50% of their patients highly engaged, and 42% of respondents said less than 25% of their patients were highly engaged.²
What can be done to improve patient participation and outcomes?
The question is what to do about it. If deeper involvement by patients results in better health outcomes, what can be done to encourage it?
Nearly 60% of the survey respondents advocated for spending more time with patients and sharing decision making, perhaps through more use of email or wireless devices. Close to 25% of respondents suggested incenting patients to improve their health, as well as giving patients more information about their conditions. But a much higher percentage of respondents deemed these two strategies - and the use of wireless devices - as the least effective patient engagement initiatives.3
A missing link: life context
The most effective strategy, however, may be one that the healthcare system is ill equipped to pursue: the personalization of healthcare.
“We know that doctors want to treat patients as individuals, and to provide the best care for each patient. But we also know that the systems and structure of medical practice, payment, and training work against individualized care,” write Saul J. Weiner, MD, and Alan Schwartz, PhD, collaborators of a research program regarding contextualized care. “Through our research studies, we have demonstrated that the failure to contextualize care is common, costly, and leads to worse health for patients.”4
For example, a 42 year old man tells his doctor that he lost his job. The doctor does not ask about the financial strain or how it's affecting his healthcare. As a result, the doctor fails to learn the patient has not been taking his asthma medication and sends him home with a new prescription at a higher dosage, one he cannot afford. A better outcome would have been switching to a generic version of the medication.5
Physicians take patient context into account well less than less than 50% of the time, according to the research. These “contextual errors” - inappropriate care plan due to inattention to a patient's circumstances and behavior - are seven times more costly than biomedical errors.6
Personalized advocacy: caring with context
Personalized advocacy is rapidly emerging as an effective solution for employers to address the missing link in patient care: life context.
Personalized advocacy uncovers what's going on with each employee member and what matters to them, not just their conditions. It prepares members to ask the right questions and partner more effectively with their providers when they seek care. And personalized advocacy supports doctors and nurses, helping them gain valuable insight into their patients and understand them as people with full life context, not just patients with a diagnosis.
The result? Increased patient engagement, the right care at the time, better health outcomes, and lower healthcare costs.
Want to learn more about Personalized Advocacy? Read the paper today.
- ¹,³ O'Brien, L., Six essential strategies to improve patient engagement, (June 2016), Becker's Hospital Review, retrieved from: https://www.beckershospitalreview.com/patient-engagement/6-essential-strategies-to-improve-patient-engagement.html
- ²,3 Volpp, K., Mohta, S. (May 12 2016), Insights Report, Improved Engagement Leads to Better Outcomes, but Better Tools Are Needed, retrieved from https://catalyst.nejm.org/patient-engagement-report-improved-engagement-leads-better-outcomes-better-tools-needed/
- 4 Weiner, S. and Schwartz, A., Contextualizing Care Blog, http://www.contextualizingcare.org/
- 5, 6 Weiner, S., (Sept. 13, 2016), Listening for What Matters: Lessons about Caring from Concealed Recordings of Medical Encounters. http://www.theschwartzcenter.org/media/Listening-for-What-Matters-HANDOUT-1.pdf