+ Patient Engagement Toolkit: Boosting Patient Knowledge, Skills and Self-efficacy Mary R. Talen, Ph.D. Director, Primary Care Behavioral Health Northwestern Family Medicine Residency Chicago, IL Behavioral Science Form 2011

+ Overview Definition and Description of Patient Engagement Research on Patient Engagement Tools For Boosting Self-Management Office-Based Practices and Patient Engagement Summary and Discussion

+ Rationale for Patient Engagement PCMH: Patient Experiences ACO: Role of Patients in Self -Management Patient-Management Support Systems Knowledge: disease and medications Skills: Communication, Shared decision-making, Goal Tracking Attitudes: Confidence and Self-efficacy

+ What Patient Engagement is Not yx0HowuA&feature=related yx0HowuA&feature=related

+ Standard Care vs. Patient Engagement Assumes knowledge drives change Clinician sets agenda Goal is compliance Decisions made by Provider Physician Mantra: “ Eat Right, Exercise Often, Take your Meds” (Bodenheimer et al, CA Health Care Foundation, 2005) (Bodenheimer et al, CA Health Care Foundation, 2005) Assumes knowledge + confidence drives change Patient participates in agenda Goal is enhanced confidence and efficacy Decisions made in collaborative partnership Standard CarePatient Engagement Care

+ What is Patient Engagement? Components of Engagement Patient education and health literacy Medication compliance Skills in chronic disease management Healthy behaviors (i.e., no smoking, nutrition, exercise) Questions and Communication Accessing Care The Ideal Engaged Patient “Actions individuals and/or families take to obtain the greatest benefit from the healthcare services available to them” (

+ Healthcare Providers and Patient Engagement “The systematic provision of education and supportive interventions to increase patients’ skills and confidence in managing their health problems, including regular assessment of progress and problems, goal setting, and problem-solving support.” Institute of Medicine Definition (2003):

+ Patient Engagement: Evidence Addressing knowledge is necessary but not sufficient to produce changes in chronic illness care outcomes Key strategies for improving outcomes of educational and behavior change interventions: assessment of patient-specific needs and barriers goal setting enhancing skills, problem-solving follow-up and support increasing access to resources Bodenheimer et al, 2002 ; Glasgow et al, 2003; Fisher et al, 2005)

+ Characteristics of Engagement Aware and Informed consumers Activated and Involved Empowered and Self-efficacy Confident in self-management Partners with health care providers Relationship Building Exploring patients’ needs, expectations and values Information Sharing and Transparency Collaborative Goal Setting Action Planning Skill Building & Problem Solving Continuity and Follow-up on progress Patient CharacteristicsHealthcare Team Characteristics

+ Conceptual Framework : Knowledge: Health Status, Disease Process, Medications Skills: Access, Communication, Decision-making Attitudes: Confidence, Self- Efficacy, Awareness

+ Patient Activation Measurement: (PAM) Identifies patient’s belief about role in healthcare Identifies patient’s health knowledge Identifies patient’s level of activation in healthcare

+ Attitudes: Patient Activation Measurement

+ Attitudes: Confidence and Self- Efficacy “They are able who think they are able.” Virgil Shift in focus from what is wrong to what is right In addition to Risk, vulnerability, loss add strength, resilience and endurance Maximize “Good News” “How were you able to accomplish that? “ “What would be good enough for now?” Identify Signature Strengths Self-EfficacyTools Positive Health Behavior Changes (Hershberger, 2005)

+ Skills: Communication with Providers Agenda Setting Talen, MR, Grampp, K, Held-Muller, C, Stevens, L, 2011

+ Skills: Making Choices Asthma Action Plans g-disease/asthma/living- with-asthma/take-control-of- your- asthma/AsthmaActionPlan- JUL2008-high-res.pdf g-disease/asthma/living- with-asthma/take-control-of- your- asthma/AsthmaActionPlan- JUL2008-high-res.pdf

+ Skills: Making Choices Decision Balance Charts SMART Specific Measurable Attainable Realistic Timetable Motivational Interviewing Process

+ Skills: Tracking Changes Diabetes Score Cards Group Medical Visits Planned Chronic Care Follow-Up Continuity Care Chronic Pain Management Health Status TrackingScore Cards

+ Skills: End of Life Decisions Primary Care’s Role in Anticipatory Guidance Opening Discussion Reflection Discussions Act ut/model-and- methodology/making-your- wishes-known-for-end-of-life- care/

+ Knowledge: Personal Health Overall level of health status Family History and Genogram Physician Teach-back Self-scoring Behavioral Health Screening sign_in.php Medline Plus: eplus/ eplus/ Mayo Clinic Patient Information Overall Health StatusConditions

+ Knowledge: Community Resources ty.org/hc/Communities/Local- Communities/default.aspx ty.org/hc/Communities/Local- Communities/default.aspx Health Promotion services/health-and- wellness-programs Erie Family Health Center Resources and Referrals

+ Obstacles and Opportunities BarriersOpportunities

+ Implementing Patient Engagement Strategies Standard Agenda Setting Forms at Check-IN Self Scoring Screening or Tracking Tools at Triage Patient Strengths and Efficacy Health activation strategies Sign-up,calls, texting for Group Medical Visits and Health Education Using Positive Health Strengths Shared Goal Setting and Tracking Case Managers-Patient Communication/relationships IT apps Office Based ProtocolsProvider – Patient Communication

+ Summary and Discussion