How do healthcare professionals working in accountable care organisations understand patient activation and engagement? Qualitative interviews across two time points

• Published in: BMJ open 2018-10, Vol.8 (10), p.e023068-e023068
• Main Authors: Mishra, Manish K, Saunders, Catherine H, Rodriguez, Hector P, Shortell, Stephen M, Fisher, Elliott, Elwyn, Glyn
• Format: Article
• Language: English
• Subjects: Accountable Care Organizations; Cardiovascular disease; Clinical decision making; Decision making; Diabetes; Empowerment; Goal setting; Health care policy; Health Personnel - psychology; Health services; Humans; Interviews as Topic; Leadership; Medical personnel; Patient Participation; Patient-centered care; Patient-Centred Medicine; Patients; Physicians, Primary Care - psychology; Primary care; Qualitative Research
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2018-023068

ObjectiveIf patient engagement is the new ‘blockbuster drug’ why are we not seeing spectacular effects? Studies have shown that activated patients have improved health outcomes, and patient engagement has become an integral component of value-based payment and delivery models, including accountable care organisations (ACO). Yet the extent to which clinicians and managers at ACOs understand and reliably execute patient engagement in clinical encounters remains unknown. We assessed the use and understanding of patient engagement approaches among frontline clinicians and managers at ACO-affiliated practices.DesignQualitative study; 103 in-depth, semi-structured interviews.ParticipantsSixty clinicians and eight managers were interviewed at two established ACOs.ApproachWe interviewed healthcare professionals about their awareness, attitudes, understanding and experiences of implementing three key approaches to patient engagement and activation: 1) goal-setting, 2) motivational interviewing and 3) shared decision making. Of the 60 clinicians, 33 were interviewed twice leading to 93 clinician interviews. Of the 8 managers, 2 were interviewed twice leading to 10 manager interviews. We used a thematic analysis approach to the data.Key resultsInterviewees recognised the term ‘patient activation and engagement’ and had favourable attitudes about the utility of the associated skills. However, in-depth probing revealed that although interviewees reported that they used these patient activation and engagement approaches, they have limited understanding of these approaches.ConclusionsWithout understanding the concept of patient activation and the associated approaches of shared decision making and motivational interviewing, effective implementation in routine care seems like a distant goal. Clinical teams in the ACO model would benefit from specificity defining key terms pertaining to the principles of patient activation and engagement. Measuring the degree of understanding with reward that are better-aligned for behaviour change will minimise the notion that these techniques are already being used and help fulfil the potential of patient-centred care.