Lisa Tayman MS, RN, CEN, CCRN Salisbury University NURS 525
Federal Policy Brief TITLE Patient Engagement. People actively involved in their health and health caretend to have better outcomes—and, some evidence suggests, lower costs
Patient Engagementcalls for reforms to achieve a patient-centered health care system, wherein individual patient preferences, needs, and values are respected and patients guide all clinical decisionscombines patient activation (a patient’s knowledge, skills, ability, and willingness to manage his or her own health care) with interventions designed to promote positive patient behavior, such as obtaining preventive care.
Patient EngagementShared Decision Making= When there are multiple, reasonable treatment options, each with their own risks and benefits, the correct path to follow should be guided by a patient’s unique needs and circumstances
Shared Decision MakingDecision aids such as: booklets, videos, websites, and interactive media are usedAll of these helpful aids will give patients information on the risks and benefits of various treatment options and help them make the choice that most reflects their personal values.
Research on Patient EngagementPatients who received enhanced decision-making support had overall lower medical costs and fewer hospital admissions than for those who received only the usual supportPeople with the least skills and confidence to actively engage in their own health care (patient activation) incur costs between 8-21% higher than patients with higher activation levels
Patient EngagementMay be affected by such factors as: cultural differences, gender, age, and educationFor patients to engage effectively, they must have a certain degree of health literacyOne strategy to incorporate into practice is the “teach-back” method
Teach-Back MethodThe provider will ask the patient to explain back to them what they have learned, such as: their own understanding of their condition, the options available to them, and their intentions to act on the information
Future ResearchMore studies need to be conducted to determine the best practices for engaging patients, as well as determining the extent of the relationship of patient engagement to health care cost savings
Patient EngagementEfforts are under way to hold health care organizations accountable for engaging patients.The National Committee for Quality Assurance surveys patients and ask about whether clinicians engage them in shared decision making or provide support for them to manage their conditions to determine if this quality measure is being met.
State Policy BriefShared decision making and being engaged in their care, increased compliance for such issues as:blood sugar testing for gestational diabetesCPAP use
TelemedicineDefinition: The use of interactive audio, video, or other telecommunications or electronic technology by a licensed health care provider to deliver health care services at a site other than the site the patient is located.
“Telemedicine Recommendations”This report addressed that effective use of telemedicine can increase access to health care, reduce health disparities, and create efficiencies in health care delivery
Telemedicine BenefitsHas the potential to increase access and reduce the cost of care.Both consumers and providers can benefit from telemedicine
TelemedicineConsumers can experience increased access to providers, quicker and more convenient treatment, better continuity of care, and a reduction in lost work time and travel costsProviders can experience instant access to other providers, a reduction of medical errors, and increased efficiency with reduced travel and research times
Research shows:Telemedicineimproves time-to-diagnosisfacilitates access to care for patients in remote regionsincreases patient satisfaction
TelemedicineTelemedicine offers an alternative to the traditional method of care delivery (face to face)Health care organizations faced with provider shortages, access disparities and budget challenges, are adopting telemedicine in order to connect geographically-remote patients with specialists, to allow scarce specialists to be available across networks, and to provide remote monitoring of patients
TelemedicineIt is recommended that payments accurately reflect the cost of delivery for providers and the effectiveness of the treatments must be proven to payers and patients.Payment must be sufficient to cover actual costs, but should not favor telemedicine over face-to-face services
Telemedicine legislationAccording to the Department of Health and Mental Hygiene, telemedicine should be used to address access to care issues related to specialists being located a long distance from patients and not as a replacement for in-person care
TELEMEDICINECurrent fiscal and policy notes: SB 494 regarding developing strategies and recommendations for advancing telemedicine technologiesSB 496 regarding the reimbursement of telemedicine services by MedicaidSB 776 regarding establishing a Task Force on the use of telehealth to improve Maryland health care
Policy recommendationsTo establish a Task Force on the use of telehealth to improve Maryland health careThis task force must assess factors related to telehealth and identify opportunities to use teleheath, as well as collaborate with organizations such as the Rural Maryland Council, and make recommendations regarding the use of telehealth in the State
Patient Engagement & TelemedicinePatient engagement combines patient activation with interventions designed to promote positive patient behaviorInterventions such as telemedicine improves time-to-diagnosis, facilitates access to care for patients in remote regions, and increases patient satisfaction
References Capistrant, G. (2013). Letter to Maryland House of Delegates. Retrieved from: http://www.americantelemed.org/docs/default-source/policy/ata-comments-on-mar Commission on Maryland Cybersecurity Innovation and Excellence-Duties. Maryland General Assembly 2013 Session, SB 494. Retrieved from: http://mgaleg.maryland.gov/webmga/frmMain.aspx?id=sb0494&stab=01&pid=billpa and http://mgaleg.maryland.gov/2013RS/fnotes/bil_0004/sb0494.pdf Health Policy Brief: Patient Engagement. (Feb. 14, 2013). Health Affairs, 1-5. Retrieved from: http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_86.pdf Homko, C.J., Santamore, W.P., Whiteman, V., Bower, M., Berger, P., Geifman- Holtzman, O., and Bove, A.A. (2007). Use of an Internet-Based Telemedicine System to Manage Underserved Women with Gestational Diabetes Mellitus. Diabetes Technology & Therapeutics, 9(3), 297-306. doi: 10.1089/dia.2006.0034
References Maryland Medical Assistance Program – Telemedicine. Maryland General Assembly 2013 Session, SB496. Retrieved from: http://mgaleg.maryland.gov/2013RS/fnotes/bil_0004/sb0494.pdf and http://mgaleg.maryland.gov/2013RS/fnotes/bil_0006/sb0496.pdf Stepnowsky, Jr., C.J., Palau, J.J., Marler, M.R., and Gifford, A.L. (2007). Pilot Randomized Trial of the Effect of Wireless Telemonitoring on Compliance and Treatment Efficacy in Obstructive Sleep Apnea. Journal of Medical Internet Research, 9(2), e14. doi: 10.2196/jmir.9.2.e14 Task Force on the use of telehealth to imfprove Maryland health care. Maryland General Assembly 2013 Session, SB 776. Retrieved from: http://mgaleg.maryland.gov/webmga/frmMain.aspx? id=sb0776&stab=01&pid=billpage&tab=subject3&ys=2013RS and http://mgaleg.maryland.gov/2013RS/fnotes/bil_0006/sb0776.pdf Telemedicine Recommendations. Maryland Quality and Cost Council, December 2011. Retrieved from: http://mhcc.dhmh.maryland.gov/hit/Telemedicine/Documents/sp.mhcc.maryland.gov/ telemed/md_telemedicine_report.pdf