What's the benefit of patient, family engagement?

In the end, practicing medicine is all about the patient. Taking care of people is the reason that clinicians go into medicine. But unintentionally, with the pressure to produce more, see more patients, and manage more complex illnesses every day, patients and their family members are sometimes not treated as part of the care team.

Research shows that when patients are actively engaged in their health care, there are measurable improvements in quality and safety, fewer malpractice claims, and even more efficient care. Research also shows that when patients are part of the team, both patients and clinicians are more satisfied and outcomes are better. (For more on patient and family engagement, see the article, “A Shifting Focus on the Role of Patients' Nonmedical Needs”.)

Effectively engaging your patients and their family members improves communication, and with better communication come more transparency and accountability. There are four reasons to begin putting more effort into increasing partnership with patients and families.

1. Better outcomes. Patients are often frustrated that the clinician does not understand how their condition affects their everyday life and that there are financial or other barriers to improvement. When patients don't improve, the clinician also becomes frustrated. Getting patients and their families engaged in their care is a strategy to find common ground or the “sweet spot” where both patient and care team achieve mutual goals of improved outcomes. When patients and families feel as if they are part of the solution, they trust their clinician, and when they trust their clinician, they are more motivated to succeed.

2. Clinician satisfaction. Clinician burnout is at an all-time high. Building relationships with patients and their family members can be very satisfying and may help boost clinician morale. Patients and families who trust their care team will have better outcomes because they feel empowered to take care of themselves, are more likely to pay their bills, and are less likely to file a malpractice claim. Additionally, patient portals can allow patients to access test results and ask questions that staff can answer, thereby reducing some phone calls and confusion in between visits. All of these things can help to alleviate some of the daily burdens placed on clinicians and their staff members.

3. Quality Payment Program credit. If you are participating in the Merit-based Incentive Payment System (MIPS) program, then improvement activities, quality measures, and performance measures promoting interoperability count toward the total MIPS score. Using the CAHPS (Consumer Assessment of Healthcare Providers and Systems) survey earns credit as both a quality measure and an improvement activity. Patient-generated health data or data from a nonclinical setting (such as social service data, advanced directives, medical device data, or home health monitoring data) incorporated into a certified EHR count toward the promoting interoperability category. CMS’ accountable care Shared Savings Programs require that patients be part of the governance as well as participate in quality improvement programs.

4. Patient-centered medical home (PCMH) credit. All of the major PCMH programs give credit for shared decision making and other collaborative activities involving patients and their families. Some payers pay a premium to practices that are PCMHs, and MIPS gives automatic credit for the Improvement Activities category to PCMH practices.

There are a few simple things that can be implemented that will go a long way toward engaging your patients:

• Start each visit by asking the patient questions, such as, “What are your priorities for your visit today?” and “What is most important for us to know as we work with you to resolve your concerns?”
• Have front desk staff provide an agenda-setting form for patients to complete in the waiting room. This agenda helps them prepare and optimize their time with the clinical team.
• Encourage patients when they schedule an appointment to bring a family member with them.
• Use a daily huddle with your team to prepare for shared decision making with patients and ensure that the needed materials, tools, and information are ready for the clinician or team members working directly with patients and families.
• Use health literacy tools to make sure patients understand their medications and conditions.

Many resources exist to help clinicians and practice teams increase patient and family involvement. The Agency for Healthcare Research and Quality offers a patient and family engagement toolkit, as well as the CAHPS surveys. The Institute for Patient- and Family-Centered Care is an organization whose mission is to advance the understanding and practice of patient- and family-centered care.

Finally, ACP's Practice Advisor includes a module on patient and family engagement with resources to help practices identify and prioritize specific actions at the point of care that will facilitate meaningful partnerships with patients.