Category Archives: Practice Enhancement

Most Effective Strategies for Optimizing Patient Engagement

October 15, 2020

There is a growing recognition of the importance of patient engagement as the key component of high-performing, cost-efficient healthcare systems which increase treatment adherence and self-monitoring as well as improve population health outcomes. Healthcare organizations who prioritize a strong team-based care infrastructure are better positioned to optimize patient engagement programming – broadly defined as the process of actively involving patients in their care and treatment decisions.

New research reveals that it is a relationship-based approach that builds trust and promotes patient autonomy, while organizational and administrative factors provide the foundation for such patient engagement. Organizations and health systems with provider champions, clear-cut staff duties, team performance improvement meetings, and staff dedicated to patient engagement tend to be more successful, according to findings published in the Annals of Family Medicine.

Optimizing Patient Engagement 

The recent study aimed to identify specific organizational factors that were associated with a greater adoption of patient engagement care practices within Veterans Health Administration (VA) primary care clinics. At these locations, patient engagement efforts were centered on the Patient-Aligned Care Team (PACT) initiative, which leverages aspects of the patient-centered medical home model to deliver comprehensive and continuous team-based care to veterans.

Investigators evaluated the adoption of PACT protocols across the VA primary care clinic system by analyzing responses from a survey completed by 2,500 clinicians at over 600 locations across the nation. Their results revealed that respondents at high-performing clinics were more likely to report regular team meetings aimed at discussing performance improvement and dedicated leadership responsible for the implementation of PACT best practices. High performance was also associated with fully-staffed PACT teams and clearly defined staff roles.

Overall, healthcare organizations only modestly implemented the recommended patient engagement tactics as results indicated a significantly lowered adoption of motivational interviewing and self-management programming.

“Lower use of these practices may be related to clinicians’ perceptions that some elements of the patient-centered medical home may not be entirely relevant (or may be difficult to use) for particular groups of patients during visits,” the researchers explained.

Organizational Factors

Revealing the importance of organizational elements, the study emphasizes the need to create new patient-centered relationships – that were found most effective for promoting patient engagement among high-performing clinics.

“Team-based care is a key driver of the use of patient engagement care processes and may directly affect patients’ level of engagement,” the study’s authors wrote. “Factors related to patients, team members, and workload may moderate the influence of team-based care on use of patient engagement care processes.”

Clear staffing roles were tied to better adherence to PACT, including motivational interviewing and organizational programming. Team-based huddles were essential for communicating quality improvement data: “Improved team collaboration and coordination are necessary for practices to manage the increasing complexity and unpredictability of clinical care and to become more accountable for patient-centered outcomes,” the authors concluded.

Next Steps

The latest findings emphasize the need to prioritize organizational elements of healthcare practices  and organizations in order to deliver care and achieve optimized patient engagement. Promoting fully-staffed facilities, identifying clearly defined roles of team members, more effective leadership, and a practice culture of performance improvement all may increase the efficacy of patient engagement initiatives and subsequently patient health outcomes.

While the team of researchers continues to examine the specific aspects of the patient-centered medical home model that most effectively improve engagement, the outlined organizational elements can be improved to better the functionality of primary care teams and enhance patient engagement in the medical care process.

Racism as a Public Health Crisis

June 26, 2020

Current events have sparked nationwide controversy, forcing organizations within all industries to look inward, reexamine their practices, and reassess their commitments to achieving and maintaining racial equality. The past few months in particular have exposed the racial health inequities disproportionately affecting African American communities as the COVID-19 pandemic has hit minority populations the hardest.

Following weeks of protests against police brutality and structural racism sparked by the killings of George Floyd, Ahmaud Arbery, and Breonna Taylor, many other healthcare groups have utilized their platforms to share outrage, condemn the injustices at hand, and promote an attitude of activism within the industry as a method of combating the impact of systemic racism on public health.

Racial Disparities in Population Health

As evidenced by recent events and the disproportionate impact of the COVID-19 pandemic on African American and marginalized communities, racism is a public health crisis.  In the United States, the health of African Americans consistently lags behind most other racial groups as black men and women face increased risks of chronic illness, infection, and injuries compared with their white counterparts. Overall, the average lifespan for African Americans is approximately 6 years less of that for whites.

While financial instability is believed to be the leading cause fueling disparities in the industry, the correlation between socioeconomic status – the strongest predictor of health outcomes – and health is primarily dependent upon race. Per data reported by MedPage Today, mortality rates for babies born to African American women with master’s or doctorate degrees are significantly higher than those for babies born to white mothers who have less than an eighth-grade education. These statistics disprove prior beliefs that education levels contribute to poorer health outcomes among this demographic. At the same time, while black women face a far lower risk of developing breast cancer risk, they are 40% more likely to die from it.

In addition, cardiovascular disease mortality rates are 22% higher in African American women than in white women, while cervical cancer mortality rates are up to 71% higher. Shockingly, African American women are 243% more likely to die from pregnancy or childbirth-related causes than their white counterparts.

Overall, African Americans have poorer health outcomes than whites across nearly every category of illness – even after controlling for external factors. This is largely a result of disparities in healthcare accessibility and systemic racism; there is a growing body of evidence that shows it is the chronicity rather than the severity of exposure to unfair treatment that most strongly correlates with higher morbidity or mortality rates among this group. Repetitive discriminatory encounters take a significant toll on the health of members of discriminated communities, as evidenced by their substandard health outcomes.

Healthcare Organizations Respond

Recent events and their ramifications express the deep-seated anger and frustration of marginalized populations experiencing inequity at every turn in need of systemic change. As evidenced by persisting disparities in health outcomes between racial groups, the healthcare industry plays a significant role in the systemic racism at hand. Healthcare organizations across the nation are uniting to deliver statements of promise and instate guidelines that aim to promote activism, support marginalized racial groups, and ultimately achieve equality.

“As places of healing, hospitals have an important role to play in the wellbeing of their communities. As we’ve seen in the pandemic, communities of color have been disproportionately affected, both in infection rates and economic impact,” Rick Pollack, president and CEO of the American Hospital Association

(AHA) told Fierce Healthcare. “The AHA’s vision is of a society of healthy communities, where all individuals reach their highest potential for health … to achieve that vision, we must address racial, ethnic and cultural inequities, including those in health care, that are everyday realities for far too many individuals. While progress has been made, we have so much more work to do.”

The Society for Healthcare Epidemiology of America (SHEA) also denounced inequalities in public health as related to both police brutality and the disparate effects of COVID-19 on racial minorities. Executives from the Association of American Medical Colleges (AAMC) called on other health groups to utilize their platforms for advocate for change.

“Over the past three months, the coronavirus pandemic has laid bare the racial health inequities harming our black communities, exposing the structures, systems, and policies that create social and economic conditions that lead to health disparities, poor health outcomes, and lower life expectancy,” David Skorton, MD, president and CEO of AAMC, and David Acosta, MD, AAMC chief diversity and inclusion officer, said in a statement.

As a country, the United States is currently facing a dual public health crisis –the coronavirus outbreak and structural racism – both claiming countless lives and exposing the dysfunctional nature of national systems. As an initial step, health system leaders are being called on to educate themselves, partner with local agencies, and implement anti-racist training to begin to dismantle structural racism.

In a statement released Harvard Chan School of Public Health, dean Michelle A. Williams underscores the shared responsibility underlying striving for change: “To understand how this manifests today, one need only examine the disparities in health care, pollution exposure, and access to green spaces, nutritious food, and educational opportunities that have long harmed health—and prematurely ended lives—in marginalized communities. While the COVID-19 pandemic has newly laid these inequities bare for all Americans to see, the underlying injustices have endured for generations. And all of us have a responsibility to acknowledge and address them.”

Before widespread change can occur within the industry, the prevalent disparities in health outcomes and healthcare accessibility across racial populations must be acknowledged. In order to initiate healthcare system reform, organizations and their leaders must advocate for and exemplify an equitable approach to medicine. Reducing current disparities will require large-scale, transformative improvement not just of the system itself, but of society at large.

Maintaining & Building Strong Patient Relationships Through Telehealth

June 3, 2020

The recent rise in telemedicine use has taken the patient-provider relationship online, offering a platform for clinicians to continue delivering care while ensuring patient health and safety by mitigating unnecessary risk of COVID-19 exposure. For some healthcare practitioners this may be their first encounter with digital care services, and they may be wondering how social distancing guidelines are going to affect the industry as a whole and more specifically, their connection with patients. Amended regulations now allow for the offering of digital medical services without a prior established relationship with patients, leading to an influx of new patient-provider relationships and an increased need for effective telehealth communication strategies.

According to a study conducted by Public Values Research, the doctor-patient relationship is the top priority for patients and an important factor for how they value the quality of care.  Although it cannot replace in-person medical care, telehealth can be used to augment the experience by providing an opportunity for building and maintaining consistent, long-lasting relationships and expanded accessibility to care. The benefits are wide-ranging; both medical professionals and their patients can develop new lines of communication and strengthen existing ones, promote continuous care, and improve overall population health outcomes.

The Patient-Provider Relationship

In today’s healthcare environment screen-side manners are just as important as good bedside manners. As the new model of virtual care negates personal contact and can make caregiving more challenging, it requires tailored strategies to help establish relationships and foster meaningful interactions with patients online. By implementing some of the telehealth best practices and communication strategies below, clinicians can help ensure a positive patient experience while strengthening these relationships.

Best Practices

Maintain a Professional Appearance 

Despite the online nature of telehealth interactions, wearing clinical apparel during virtual visits is an important component of conveying professionalism, trust, and quality of care. Per an article published on Patient Engagement HIT, “Dressing the part will go a long way in instilling confidence in a patient receiving care via telehealth, especially for the first time, as will using body language.”

Maintaining a professional appearance relies on more than simply wearing a lab coat during telehealth appointments; physical cues such as looking into the camera, paying close attention, and reducing distractions all play a significant role in the patient’s perception of provider engagement and their satisfaction with the visit.

Give Patients Your Undivided Attention

Clinicians need to remember that 70% of all language is non-verbal and thus, body language and other physical cues can influence a telehealth encounter. Therefore, clinicians should avoid taking notes during appointments, writing or entering data in the electronic medical record, and any other forms of multi-tasking to give patients their undivided attention. Healthcare providers should also remain aware of their facial expressions as these can convey both positive and negative emotions to the patient – such as compassion, disinterest, or carelessness – and look directly into the camera instead of the patient’s on-screen image. 

Be Prepared

As part of ensuring a successful, positive patient experience, clinicians need to be well-prepared for virtual visits with all of the necessary tools at hand. However, proper preparation includes more than access to medical equipment; to guarantee a seamless online interactions clinicians should do the following:

–       Understand how to use equipment and test it beforehand
–       Ensure proper camera, microphone, and speaker placement
–       Clear the physical space of distractions
–       Ensure good lighting
–       Keep interactions private and secure
–       Wear professional clothes, solid and preferably light blue colors
–       Review patient history and electronic medical records before the appointment
 

Establish Rapport

Creating an open, warm environment via remote technology can be difficult yet remains paramount. Part of ensuring a positive overall telehealth experience is communicating empathy despite distance and time constraints so as to establish a meaningful connection with patients.

“Telehealth visits may not be any longer than ten to fifteen minutes. So, establishing a rapport immediately is important,” Jonathan Mack, PhD, RN, NP, director of a telehealth training program at the University of California San Diego told Patient Engagement HIT in an interview. “People tend to look down at the screen during video calls, so that translates to someone on the other side as not maintaining eye contact. The clinician needs to be trained to listen and look into the camera because that’s what’s going to appear on the screen for the patient as though the provider is looking at the patient.”

Establishing rapport and clear, emphatic communication can have a significant impact on the success of telemedicine visits, driving satisfaction while further strengthening patient-provider relationships.

The Many Benefits of Telehealth 

Research has found that an established patient-provider relationship is associated with fewer and shorter hospitalizations, increased reported patient satisfaction, as well as more consistent utilization of preventative strategies. In addition, the number of missed appointments decreases with the use of telemedicine, which can help prevent adverse long-term complications and poor health outcomes.

The convenience and increased engagement of patients with providers associated with telemedical strategies can also replace the urgent care or ER visit, further strengthening the doctor-patient relationship.

From a financial standpoint, telemedicine visits tend to be cheaper than office visits for patients and costs saved from diverting patient use of expensive healthcare facilities (e.g. emergency care) can generate long-term savings.

Looking professional, being prepared, communicating clearly, and establishing rapport are all effective communication strategies that can foster positive patient-provider interactions. Implementing these best practices can help clinicians guarantee a high level of patient satisfaction and quality of care during telemedicine encounters as well as during future in-person services.

From a post-pandemic perspective, continued use of telehealth strategies can be expected for the benefit of the entire healthcare system, both as it recovers from outbreak demands and beyond. With this in mind, providers utilizing telemedicine to care for their patients at this time can better position themselves to form lasting, dependable patient-provider relationships and prepare for a future of remote medical care.