Developing Interventions And Policies Patient And Family Engagement : A Framework For Understanding The Elements And Christine

Patient and family engagement offers a promising pathway toward better-quality health care, more-efficient care, and improved population health. Since definitions of patient engagement and conceptions of how it works vary, we propose a framework.We first present the forms engagement can take, ranging from consultation to partnership. We discuss the levels at which patient engagement can occur across the health care system, from the direct care setting to incorporating patient engagement into organizational design, governance, and policy making. We also discuss the factors that influence whether and to what extent engagement occurs. We explore the implications of our multidimensional framework for the development of interventions and policies that support patient and family engagement, and we offer a research agenda to investigate how such engagement leads to improved outcomes. P atient engagementhas been called a critical part of a continuously learning health system, a necessary condition for the redesign of the health care system, the “holy grail” of health care, and the next “blockbuster drug of the century.” But definitions of patient engagement and conceptions of how it improves care vary considerably. Angela Coulter’s well-known definition focuses on the relationship between patients and health care providers as they work together to “promote and support active patient and public involvement in health and healthcare and to strengthen their influence on healthcare decisions, at both the individual and collective levels.” A model of public engagement developed by James Conway at the Institute for Healthcare Improvement is organized around the settings in which patient engagement occurs: during the care experience, within the microsystem of the clinic or ward, within the health care organization, and within the larger community. And the Center for Advancing Health’s engagement behavior framework focuses on behavior, defining engagement as “actions people take for their health and to benefit from health care” and providing a list of patient-initiated engagement actions. Adding to the confusion, the term patient engagement is also used synonymously with patient activation and patientand family-centered care. Although the concepts are related, they are not identical. Patient activation—an “individual’s knowledge, skill, and confidence for managing his/her own health and health care”—is one aspect of an individual’s capacity to engage in that care. But this term does not address the individual’s external context, nor does it focus on behavior. “Patientand family-centered care” is a broader term that conveys a vision for what health care should be: “a partnership among doi: 10.1377/hlthaff.2012.1133