1. The document discusses patient engagement behaviors which are actions individuals must take to benefit from available health care services. 2. A review found that for most engagement behaviors, one third or less of people regularly perform them, while two thirds do them sporadically or not at all. 3. Patterns in the data show that people are more likely to participate in simpler, predictable tasks but participation is often shallow. People prefer just-in-time information to solve immediate problems over ongoing engagement.

1. Engagement:
Do People Engage to Get the
Care They Need?
April 15, 2010

2. Advances in health care
simultaneously promise
better outcomes while
demanding more from us
more from us

3. My own efforts were
critical to the success of
my care.
my care

4. We must participate
actively and
knowledgeably in our care
if we are to realize its
if t li it
benefits.
benefits

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

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. 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. 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

13. 1. Many people do not
yp p
take many of these
actions.

14. 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

15. 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.

16. 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.

17. 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

18. 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

19. How big is the problem of
H bi i th bl f
non‐participation in our
non‐participation in our
health care?
health care?

20. Use existing government‐
U i i
and foundation‐
and foundation
supported national
supported national
surveys.
y

21. Dominated by questions
Dominated by questions
about services received
and experience of receiving
them

22. 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

23. 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.

24. 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

25. Less likely to act to coordinate
our care
More likely to check whether
y
our health plan will cover a
specific service or test

26. 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

27. 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

28. Less likely to do every‐
y y
day health promotion
More likely to do one‐
More likely to do one
shot preventive services
p

29. Less likely to use objective
quality ratings
lit ti
More likely to seek
information to solve
immediate problems
i di t bl

30. 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

31. Are we willing to be the
g
only health care
providers about whose
behavior there is so
behavior there is so
little evidence?

32. Our efforts are critical
O ff ii l
to the success of the
to the success of the
health care enterprise.