Engagement:
   Do People Engage to Get the
        Care They Need?

April 15, 2010
Advances in health care 
simultaneously promise
better outcomes while 
demanding more from us
            more from us
My own efforts were 
critical to the success of 
          my care.
          my care
We must participate 
       actively and 
knowledgeably in our care 
  if we are to realize its 
  if        t      li it
...
What does it take for those 
What does it take for those
to find and make use of
to find and make use of
safe, decent heal...
Engagement Behaviors
    E        tB h i

=  Actions individuals must take to 
obtain benefit of available services
Engagement Behaviors
    E        tB h i

=  Actions individuals must take to 
obtain benefit of available services
 A i
...
Engagement Behaviors
    E        tB h i

=   Actions individuals must take to 
    Actions individuals must take to
obtai...
APPROACH
1. 210 patient / caregiver interviews
        p       /     g
2. Review literatures:
   a.  advocacy / non profit...
1.  Many people do not 
       yp p
  take many of these 
       actions. 
2.  Not an indictment.

Rather, a description of 
       ,        p
specific behavioral 
outcomes linked directly to 
heal...
3.  No one has to do all 
  these things today. 

Everyone has to do most 
Everyone has to do most
 of these things at som...
4.  Many of us need help 
        y                 p
    to do these things.  

 All of us need to know
     of us need t...
Patient‐centered care 
   P i            d
 describes what PROVIDERS 
 describes what PROVIDERS
            do.

EBF descr...
To the extent that a primary 
                      p     y
 care providers and settings 
      help make it easier 
    t...
How big is the problem of 
H   bi i th       bl      f
 non‐participation in our 
 non‐participation in our
      health c...
Use existing government‐
U     i i
    and foundation‐
    and foundation
   supported national 
   supported national
   ...
Dominated by questions 
 Dominated by questions
  about services received 
and experience of receiving 
           them
21 national surveys, 4 regional

Identified questions to match 
Identified questions to match
engagement behaviors on EBF
...
For the vast majority of behaviors, 
 one third or less of respondents 
      thi d l         f      d t
said that they re...
More likely to report having 
More likely to report having
a regular doctor 

Less likely to actually bring
     likely to...
Less likely to act to coordinate 
our care 

More likely to check whether 
           y
our health plan will cover a 
spec...
More lik l
      likely to discuss 
                di
potential benefits of a test 
potential benefits of a test
or treat...
Less likely to follow 
treatment plans for non‐
treatment plans for non
threatening illnesses
            g

More likely t...
Less likely to do every‐
          y           y
day health promotion

More likely to do one‐
More likely to do one
shot p...
Less likely to use objective 
quality ratings
    lit    ti

More likely to seek 
information to solve 
immediate problems...
PATTERNS
1.
1  Simpler tasks
   Simpler tasks
2. Participation shallow
          p
3. Prefer just‐in‐time
4.
4  Predictabl...
Are we willing to be the 
               g
    only health care 
providers about whose 
  behavior there is so 
  behavior...
Our efforts are critical 
O     ff          ii l
 to the success of the 
 to the success of the
health care enterprise.
Jessie Gruman
Jessie Gruman
Jessie Gruman
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Jessie Gruman

  1. 1. Engagement: Do People Engage to Get the Care They Need? April 15, 2010
  2. 2. Advances in health care  simultaneously promise better outcomes while  demanding more from us more from us
  3. 3. My own efforts were  critical to the success of  my care. my care
  4. 4. We must participate  actively and  knowledgeably in our care  if we are to realize its  if t li it benefits. benefits
  5. 5. What does it take for those  What does it take for those to find and make use of to find and make use of safe, decent health care?
  6. 6. Engagement Behaviors E tB h i =  Actions individuals must take to  obtain benefit of available services
  7. 7. Engagement Behaviors E tB h i =  Actions individuals must take to  obtain benefit of available services  A i Actions of professionals or   f f i l p policies of institutions
  8. 8. Engagement Behaviors E tB h i =   Actions individuals must take to  Actions individuals must take to obtain benefit of available services  Actions of professionals or   policies of institutions policies of institutions  Compliance
  9. 9. APPROACH 1. 210 patient / caregiver interviews p / g 2. Review literatures: a.  advocacy / non profit a. advocacy / non‐profit b.  peer reviewed c.  systematic reviews (Cochrane) c systematic reviews (Cochrane) 3. 57 key informant interviews:  professionals, researchers, advocates professionals researchers advocates 4. Draft EBF review by 30 stakeholders
  10. 10. 1.  Many people do not  yp p take many of these  actions. 
  11. 11. 2.  Not an indictment. Rather, a description of  , p specific behavioral  outcomes linked directly to  health care and indirectly  health care and indirectly to health outcomes
  12. 12. 3.  No one has to do all  these things today.  Everyone has to do most  Everyone has to do most of these things at some  point. 
  13. 13. 4.  Many of us need help  y p to do these things.   All of us need to know of us need to know  p that we are expected to  do them. 
  14. 14. Patient‐centered care  P i d describes what PROVIDERS  describes what PROVIDERS do. EBF describes what PATIENTS  EBF describes what PATIENTS must do to benefit from  their  care,  patient‐centered or not. patient‐centered or not
  15. 15. To the extent that a primary  p y care providers and settings  help make it easier  to do these behaviors,  to do these behaviors it will be patient‐centered. p
  16. 16. How big is the problem of  H bi i th bl f non‐participation in our  non‐participation in our health care?  health care?
  17. 17. Use existing government‐ U i i and foundation‐ and foundation supported national  supported national surveys. y
  18. 18. Dominated by questions  Dominated by questions about services received  and experience of receiving  them
  19. 19. 21 national surveys, 4 regional Identified questions to match  Identified questions to match engagement behaviors on EBF Pulled data on each question Pulled data on each question
  20. 20. For the vast majority of behaviors,  one third or less of respondents  thi d l f d t said that they regularly performed  y g yp it.  Two thirds did it sporadically or  Two thirds did it sporadically or not at all. 
  21. 21. More likely to report having  More likely to report having a regular doctor  Less likely to actually bring likely to actually bring  up concerns or ask  up concerns or ask questions
  22. 22. Less likely to act to coordinate  our care  More likely to check whether  y our health plan will cover a  specific service or test
  23. 23. More lik l likely to discuss  di potential benefits of a test  potential benefits of a test or treatment with our  provider  Less likely to share in the likely to share in the  decision‐making g
  24. 24. Less likely to follow  treatment plans for non‐ treatment plans for non threatening illnesses g More likely to follow  M lik l t f ll treatment plan for more  p threatening
  25. 25. Less likely to do every‐ y y day health promotion More likely to do one‐ More likely to do one shot preventive services p
  26. 26. Less likely to use objective  quality ratings lit ti More likely to seek  information to solve  immediate problems i di t bl
  27. 27. PATTERNS 1. 1 Simpler tasks Simpler tasks 2. Participation shallow p 3. Prefer just‐in‐time 4. 4 Predictable barriers don’t  Predictable barriers don’t explain all non‐participation p p p 5. Uncertain meaning of  Internet use I t t
  28. 28. Are we willing to be the  g only health care  providers about whose  behavior there is so  behavior there is so little evidence?
  29. 29. Our efforts are critical  O ff ii l to the success of the  to the success of the health care enterprise.

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