Patient engagement in the process of planning and designing outpatient care improvements at the Veterans Administration Health‐care System: findings from an online expert panel

• Published in: Health expectations : an international journal of public participation in health care and health policy 2017-02, Vol.20 (1), p.130-145
• Main Authors: Khodyakov, Dmitry, Stockdale, Susan E., Smith, Nina, Booth, Marika, Altman, Lisa, Rubenstein, Lisa V.
• Format: Article
• Language: English
• Subjects: Ambulatory Care - standards; Ambulatory medical care; Anxiety; Clinical decision making; Decision making; Delphi method; Delphi Technique; Dietary supplements; ExpertLens; Experts; Feasibility; Feasibility studies; Female; Health; Health care delivery; Health care reform; Health promotion; Health services; Humans; Internet; Male; Medical care; Military hospitals; modified Delphi; On-line systems; online expert panel; Original Research Paper; Original Research Papers; Outpatient care facilities; Outpatient treatment; Patient communication; patient engagement; Patient Participation; Patient safety; Patient satisfaction; Patient-centered care; Patients; Physician patient relationships; Quality control; Quality Improvement; Quality management; Quality of care; Quality of Health Care; Stakeholders; United States; United States Department of Veterans Affairs; Veterans
• ISSN: 1369-6513; 1369-7625
• DOI: 10.1111/hex.12444

Context There is a strong interest in the Veterans Administration (VA) Health‐care System in promoting patient engagement to improve patient care. Methods We solicited expert opinion using an online expert panel system with a modified Delphi structure called ExpertLens™. Experts reviewed, rated and discussed eight scenarios, representing four patient engagement roles in designing and improving VA outpatient care (consultant, implementation advisor, equal stakeholder and lead stakeholder) and two VA levels (local and regional). Rating criteria included desirability, feasibility, patient ability, physician/staff acceptance and impact on patient‐centredness and care quality. Data were analysed using the RAND/UCLA Appropriateness Method for determining consensus. Findings Experts rated consulting with patients at the local level as the most desirable and feasible patient engagement approach. Engagement at the local level was considered more desirable than engagement at the regional level. Being an equal stakeholder at the local level received the highest ratings on the patient‐centredness and health‐care quality criteria. Conclusions Our findings illustrate expert opinion about different approaches to patient engagement and highlight the benefits and challenges posed by each. Although experts rated local consultations with patients on an as‐needed basis as most desirable and feasible, they rated being an equal stakeholder at the local level as having the highest potential impact on patient‐centredness and care quality. This result highlights a perceived discrepancy between what is most desirable and what is potentially most effective, but suggests that routine local engagement of patients as equal stakeholders may be a desirable first step for promoting high‐quality, patient‐centred care.