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connectedness and continuity: a prescription for patient engagement
- 1. blueshieldcafoundation.org Feb. 25, 2013 connectedness and continuity: a prescription for patient engagement Institute of Medicine Roundtable on Value & Science-Driven Health Care Washington, DC. Presenter: Gary Langer Langer Research Associates glanger@langerresearch.com
- 2. blueshieldcafoundation.orgpage 2 BSCF research program changing 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
- 3. blueshieldcafoundation.org connectedness and continuity What 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) page 3
- 4. blueshieldcafoundation.org the impact Wanting 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 page 4
- 7. blueshieldcafoundation.orgpage 7 leveling the playing field preference for an equal say
- 8. blueshieldcafoundation.orgpage 8 the path to patient-centered care: a model of empowerment and engagement
- 9. blueshieldcafoundation.org 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 engagement based on results from the 2012 BSCF survey of low-income Californians page 9 connectedness continuity engagement empowerment:
- 10. blueshieldcafoundation.org connectedness and information page 10 connectednessconnectedness continuity engagement comfortable asking provider questions provider usually explains things in a way you understand confident you can make healthcare decisions feel informed about your healthfeel informed about your health empowerment:
- 11. blueshieldcafoundation.orgpage 11 the impact of connectedness on feeling informed about one’s health among low-income Californians with a personal connection among low-income Californians who lack a personal connection
- 12. blueshieldcafoundation.org continuity and information page 12 connectedness continuitycontinuity engagement comfortable asking provider questions provider usually explains things in a way you understand confident you can make healthcare decisions feel informed about your healthfeel informed about your health Empowerment:
- 13. blueshieldcafoundation.orgpage 13 the impact of continuity on feeling informed about one’s health among those who usually see the same provider among those who see the same provider less often
- 14. blueshieldcafoundation.org connectedness and further empowerment page 14 connectednessconnectedness continuity engagement comfortable asking provider questions comfortable asking provider questions provider usually explains things in a way you understand provider usually explains things in a way you understand confident you can make healthcare decisions confident you can make healthcare decisions feel informed about your health empowerment:
- 15. blueshieldcafoundation.orgpage 15 the impact of connectedness on further empowerment measures
- 16. blueshieldcafoundation.org continuity and further empowerment page 16 connectedness continuitycontinuity engagement comfortable asking provider questions comfortable asking provider questions provider usually explains things in a way you understand provider usually explains things in a way you understand confident you can make healthcare decisions confident you can make healthcare decisions feel informed about your health empowerment:
- 17. blueshieldcafoundation.orgpage 17 the impact of continuity on further empowerment measures
- 18. blueshieldcafoundation.org the importance of information page 18 connectedness continuity engagement comfortable asking provider questions comfortable asking provider questions provider usually explains things in a way you understand provider usually explains things in a way you understand confident you can make healthcare decisions confident you can make healthcare decisions feel informed about your healthfeel informed about your health empowerment:
- 19. blueshieldcafoundation.orgpage 19 the impact of information on other empowerment measures
- 20. blueshieldcafoundation.org empowerment and engagement page 20 connectedness continuity engagementengagement comfortable asking provider questions comfortable asking provider questions provider usually explains things in a way you understand provider usually explains things in a way you understand confident you can make healthcare decisions confident you can make healthcare decisions feel informed about your healthfeel informed about your health empowerment:
- 21. blueshieldcafoundation.orgpage 21 empowerment and engagement % who report having a great deal of say in their care yes yes yes yesno no no no very informed? very comfortable asking questions? always understand provider? very confident can make HC decisions?
- 22. blueshieldcafoundation.orgpage 22 one route: team-based care
- 23. blueshieldcafoundation.orgpage 23 58% 56% 52% 47% 46% 42% satisfaction with care very informed about health always understand providers' instructions among those who have team-based care among those who do not have team-based care the impact of team-based care
- 24. blueshieldcafoundation.orgpage 24 48% 35% have someone who knows you well among those who have team- based care among those who do not have team-based care team care II 51% 51% 32% have someone who knows you well private doctors' office patients overall clinic patients with team-based care clinic patients who lack team-based care
- 25. blueshieldcafoundation.orgpage 25 Rx for patient engagement connectedness and continuity pave the path to patient empowerment and engagement information 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
- 26. blueshieldcafoundation.org 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 modeling page 26
- 27. blueshieldcafoundation.org thank you! Institute of Medicine Roundtable on Value & Science-Driven Health Care Washington, DC. Presenter: Gary Langer Langer Research Associates glanger@langerresearch.com
Editor's Notes
- first report: focuses on patient-provider relationships how connected do patients feel with their providers, and does it matter? what stands behind expressed preferences for a traditional doctor-patient relationship? are patients open to alternatives? do alternative models establish the connectedness that patients seek? second report: examines shared decision making and, more broadly, the drivers of patient empowerment and engagement what’s behind reluctance to engage in care decisions? what is the relationship between information and empowerment? how do these relate to patient engagement? how do connectedness and continuity fit into the equation? can a data-driven model of patient engagement be constructed?
- the real takeaway from this chart is how universally high interest in shared decision making rises when accompanied by clear information. For example, the 25 point education gap shrinks to 7 points (a non significant difference).
- Controlling for other factors, the results of this survey show that connectedness and continuity predict “empowerment” outcomes – feeling well-informed, being comfortable asking questions of care providers, understanding providers’ answers and being confident in the ability to make healthcare decisions. Feeling well-informed also independently predicts the other three empowerment items. And each of the empowerment measures predicts “engagement,” that is, taking a role in healthcare decisions – a key goal of patient-centered care.
- those who have a connection are 27pts more likely to feel very informed about their health.
- those who have continuity are 21pts more likely to feel very informed.
- Notably, the extent to which patients feel informed about their health and confident about taking a role in their care decisions predicts their engagement independently of – and more strongly than – their education, income, gender, race/ethnicity, language spoken at home, and the type of care facility they use. That suggests that clear information can help level the healthcare playing field across population groups.
- also works for satisfaction with current amount of say – more empowered patients are more likely to be satisfied with the amount of say they currently have.
- while a regular personal doctor is still the preferred method of establishign connectedness and continuity, it is not the only way. Many are open to seeing a non-doctor care provider, especially under specific negative circumstances (e.g., when getting an appointment with a doctor is more difficult). And interest in new alternative care models is high.
- 54% of those who have a private doctor overall have someone who knows them well. 51% of those who have a private doctor (but no team-based care) have someone who knows them well. In part because team-based care establishes the connectedness patients seek (as we’ll show in the model later), those who have team-based care are also more likely to feel satisfied with their care, feel very informed about their health, and report being able to always understand their providers explanations. BUT team-based care is a unique predictor of empowerment even when you control for having a personal connection and having a personal doctor, etc.