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Structured Abstract
Objective:
The widely applied Chronic Care Model emphasizes the need for an “informed activated patient” and a “prepared and proactive team” to improve patient outcomes. This Technical Brief applies a framework to create a map of the currently available evidence on patient and family engagement strategies that have been used to help people manage chronic conditions.
Methods:
We adapted a framework for patient, family, and caregiver engagement. Key Informants provided input on the framework for categorizing different types of engagement strategies. We searched PubMed and CINAHL from January 2015 to January 2020 to identify relevant systematic reviews and to identify original research articles focused on health system and community/policy levels, which were not covered well by systematic reviews. Our gray literature search focused on reports by national organizations.
Results:
Guided by our framework, we categorized patient and family engagement strategies into direct patient care, health system, and community/policy levels. The search yielded 134 systematic reviews. Of those, 126 reviews focused on the direct patient care level, 5 on the health system level, and none on the community level. Eight reviews (five with studies having comparison groups and three with studies lacking comparison groups) reported implementation outcomes. The number of studies per review ranged from 0 to 488 studies for the direct patient care level. Reviews on direct patient care level engagement mostly focused on self-management support (88) and shared decision making (34), and many used mobile health and electronic health record tools to improve engagement. The majority included studies of adults (96), while only 14 focused on children. Self-management support strategies were mostly tested as part of multicomponent interventions. Multiple technology-based modalities were used. The most frequently reported clinical outcomes were adherence to medication/self-care plans, and measures of chronic disease control (e.g., hemoglobin A1c and blood pressure control). For self-management in adults, 26 reviews reported positive effects, 18 reported potential benefits, and 19 reported unclear benefits. None reported any harms. Most reviews of shared decision making also described multicomponent interventions. Seven showed positive effects, ten showed potential benefits, eight showed unclear benefits, and one showed no benefits. Health system–level strategies most commonly involved patients and family caregivers serving on patient and community advisory councils and participating in meetings or project teams. No rigorous evaluations were reported on these strategies. One original article was identified that described patient engagement at the community level and focused on a neighborhood-clinic partnership.
Conclusions:
Patient and family engagement strategies with the greatest evidence pertain to self-management support for adults with chronic conditions. Use of technology to facilitate patient and family engagement is a promising approach. Few studies examined advanced care planning or interventions for patients with multiple chronic conditions. More research is needed to address a big gap in evidence on patient and family engagement at the health system and community/policy levels.
Contents
- Preface
- Acknowledgments
- Key Informants
- Peer Reviewers
- Evidence Summary
- Introduction
- Methods
- Results
- Discussion and Implications
- Conclusion
- References
- Appendix A. Search Strategies
- Appendix B. Evidence Tables
- Appendix C. Summary Table for Gray Literature Search
- Appendix D. List of Excluded Studies for Systematic Reviews
- Appendix E. List of Excluded Studies for Original Articles
- Appendix F. List of Included Studies for Original Articles
- Appendix G. Word Cloud
Suggested citation:
Bennett WL, Pitts S, Aboumatar H, Sharma R, Smith BM, Das A, Day J, Holzhauer K, Bass EB. Strategies for Patient, Family and Caregiver Engagement. Technical Brief. (Prepared by the Johns Hopkins University Evidence-based Practice Center under Contract No. 290-2015-00006-I.) AHRQ Publication No. 20-EHC017. Rockville, MD: Agency for Healthcare Research and Quality; August 2020. DOI: https://doi.org/10.23970/AHRQEPCTB36. Posted final reports are located on the Effective Health Care Program search page.
This report is based on research conducted by the Johns Hopkins University Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2015-00006-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.
The information in this report is intended to help healthcare decision makers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of healthcare services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.
This report is made available to the public under the terms of a licensing agreement between the author and the Agency for Healthcare Research and Quality. This report may be used and reprinted without permission except those copyrighted materials that are clearly noted in the report. Further reproduction of those copyrighted materials is prohibited without the express permission of copyright holders.
AHRQ or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies may not be stated or implied.
AHRQ appreciates appropriate acknowledgment and citation of its work. Suggested language for acknowledgment: This work was based on an evidence report, Strategies for Patient, Family and Caregiver Engagement, by the Evidence-based Practice Center Program at the Agency for Healthcare Research and Quality (AHRQ).
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