Types of Engagement Strategies to Engage High-Risk Patients in VA

• Published in: Journal of general internal medicine : JGIM 2023-11, Vol.38 (15), p.3288-3294
• Main Authors: Bergman, Alicia A., Stockdale, Susan E., Zulman, Donna M., Katz, Marian L., Asch, Steven M., Chang, Evelyn T.
• Format: Article
• Language: English
• Subjects: Community involvement; Community support; Empowerment; Health care; Health Personnel; Humans; Internal Medicine; Medical personnel; Medicine; Medicine & Public Health; Original Research: Qualitative Research; Patient Participation; Patients; Physicians; Primary care; Risk; Risk groups; Teams
• ISSN: 0884-8734; 1525-1497; 1525-1497
• DOI: 10.1007/s11606-023-08336-8

Background Many healthcare systems seek to improve care for complex high-risk patients, but engaging such patients to actively participate in their healthcare can be challenging. Objective To identify and describe types of patient engagement strategies reported as successfully deployed by providers/teams and experienced by patients in a Veterans Health Administration (VA) intensive primary care (IPC) pilot program. Methods We conducted semi-structured qualitative telephone interviews with 29 VA IPC staff (e.g., physicians, nurses, psychologists) and 51 patients who had at least four IPC team encounters. Interviews were recorded, transcribed, and analyzed thematically using a combination a priori/inductive approach. Results The engagement strategies successfully deployed by the IPC providers/teams could be considered either more “facilitative,” i.e., facilitated by and dependent on staff actions, or more “self-sustaining,” i.e., taught to patients, thus cultivating their ongoing patient self-care. Facilitative strategies revolved around enhancing patient access and coordination of care, trust-building, and addressing social determinants of health. Self-sustaining strategies were oriented around patient empowerment and education, caregiver and/or community support, and boundaries and responsibilities. When patients described their experiences with the “facilitative” strategies, many discussed positive proximal outcomes (e.g., increased access to healthcare providers). Self-sustaining strategies led to positive (self-reported) longer-term clinical outcomes, such as behavior change. Conclusion We identified two categories of strategies for successfully engaging complex, high-risk patients: facilitative and self-sustaining. Intensive primary care program leaders may consider thoughtfully building “self-sustaining” engagement strategies into program development. Future research can confirm their effectiveness in improving health outcomes.