connectedness and continuity: a prescription for patient engagement
TRANSCRIPT
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blueshieldcafoundation.org Feb. 25, 2013
connectedness and continuity:a prescription for patient engagement
Institute of Medicine Roundtable on Value & Science-Driven Health CareWashington, DC.
Presenter:Gary LangerLanger Research [email protected]
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BSCF research programchanging health care paradigm for low-income Californians• ACA introduces competition; providers will need to respond
spring 2011: baseline survey of healthcare experiences and preferences • establish drivers of patient loyalty
two drill-downs emerge:• expressed desire for a regular personal doctor• substantial resistance to shared decision making
spring 2012: explore these and other potential drivers of patient empowerment and engagement
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connectedness and continuityWhat patients say they want…
… a regular personal doctor
What patients mean they want…
….connectedness (a sense someone there “knows you pretty well”)
…and continuity (an assurance you’ll see the same caregiver over time)
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the impactWanting but lacking a personal doctor independently (negatively)
predicts satisfaction with care and patient loyalty…
But when connectedness and continuity are added to the equation, they independently (positively) predict satisfaction, empowerment and engagement alike – and having a regular personal doctor does not
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shared decision making
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shared decision making
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leveling the playing fieldpreference for an equal say
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the path to patient-centered care:a model of empowerment and
engagement
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confident you can make healthcare decisions
provider usually explains things in a way you understand
comfortable asking provider questions
feel informed about your health
a model of patient engagementbased on results from the 2012 BSCF survey of low-income Californians
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connectedness
continuityengagement
empowerment:
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connectedness and information
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connectedness
continuityengagement
comfortable asking provider questions
provider usually explains things in a way you understand
confident you can make healthcare decisions
feel informed about your health
empowerment:
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the impact of connectednesson feeling informed about one’s health
among low-income Californians with a personal connection
among low-income Californians who lack a personal connection
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continuity and information
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connectedness
continuityengagement
comfortable asking provider questions
provider usually explains things in a way you understand
confident you can make healthcare decisions
feel informed about your health
Empowerment:
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the impact of continuityon feeling informed about one’s health
among those who usually see the same provider
among those who see the same provider less often
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connectedness and further empowerment
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connectedness
continuityengagement
comfortable asking provider questions
provider usually explains things in a way you understand
confident you can make healthcare decisions
feel informed about your health
empowerment:
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the impact of connectedness on further empowerment measures
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continuity and further empowerment
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connectedness
continuityengagement
comfortable asking provider questions
provider usually explains things in a way you understand
confident you can make healthcare decisions
feel informed about your health
empowerment:
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the impact of continuity on further empowerment measures
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the importance of information
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connectedness
continuityengagement
comfortable asking provider questions
provider usually explains things in a way you understand
confident you can make healthcare decisions
feel informed about your health
empowerment:
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the impact of information on other empowerment measures
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empowerment and engagement
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connectedness
continuityengagement
comfortable asking provider questions
provider usually explains things in a way you understand
confident you can make healthcare decisions
feel informed about your health
empowerment:
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empowerment and engagement% who report having a great deal of say in their care
yes yes yes yesno no no novery informed? very comfortable
asking questions?
always understand provider?
very confident can make HC
decisions?
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one route: team-based care
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58% 56% 52%47% 46% 42%
satisfaction withcare
very informed abouthealth
always understandproviders' instructions
among those who have team-based careamong those who do not have team-based care
the impact of team-based care
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team care II
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Rx for patient engagement
connectedness and continuity pave the path to patient empowerment and engagementinformation is essential;• it predicts self-efficacy even when connectedness and continuity are held
constant• …and it does so more strongly than education, income, gender, race and other
demographic variables
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and a word on measurement(inspired by our literature reviews)
• attitudinal measurements in non-probability samples are not generalizable •aapor task force report (2010)
• agree/disagree and yes/no questions are inherently biasing•Saris et al., Survey Research Methods (2010) 4/1: 61-79
• unlabeled or partially labeled number scales often lack internal validity•Krosnick & Fabrigar, Sociological Methods & Research (2009)
37: 393-425
• knowledge is problematic to measure in an opinion survey format•challenges are cognitive, measurement-based and definitional
• data analysis is enriched by rigorous statistical modelingpage 26
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thank you!Institute of Medicine Roundtable on Value & Science-Driven Health CareWashington, DC.
Presenter:Gary LangerLanger Research [email protected]