We're going to be talking in this segment about patient and family centered care and engagement. And, this is really how we move from patient and family centered care, to engaged care, to activated care. So, let's put the pieces together. We have the patient experience, which we'll define. We have patient and family centered care engagement activation. So, the Johns Hopkins definition of the patient experience is based partly on patient's and family's high expectations about what is to happen and their cumulative evaluation of their journey through our system. We have the opportunities to delight or disappoint based on their clinical and emotional interactions with us, as well as the interactions with our people, our processes and our physical setting. And, this won't change whether you're looking at patient and family centered care, engaged care, or activated care. Patients will still have their experience through your system, whether it's the outpatient or the inpatient, home health, or rehab. The focus on patient centered care, one of the earlier works on it, was the Institute of Medicine's report that listed patient centered care as one of the six priorities for health care in the 21st century. This was followed by the National Quality forum's top six priority and goals for patient centered care and engagement. And, this included engaging patients and families in managing their health and making decisions about their care, improving the health of the population, improving the safety and reliability of America's health care system, ensuring patients receive well coordinated care within and across all health care organizations, settings, and levels of care, guaranteeing appropriate and compassionate care for patients with life limiting illnesses, and finally, eliminating overuse while ensuring the delivery of appropriate care. This also became part of the Affordable Care Act in 2010. At Johns Hopkins Medicine, our patient and family centered care definition is from the Institute for patient and family centered care. And what we've said, that this is an approach to the planning, delivery, and evaluation of health care that's grounded in mutually beneficial partnerships among health care providers, patients, and families. And, it really redefines the relationships in health care. The core principles of patient and family centered care are respect and dignity, information sharing, participation, and collaboration. And, collaboration includes not only collaboration about your own care, but collaboration with the organization in improving the way that they organize and provide care. This is where you'll find patients and family advisory committees and patients and families on committees at the hospitals. So, the dimensions of patient or person and family centered care, and we're moving a little bit more to thinking about person centered care, is respect for patients' values, preferences and expressed needs. The coordination and integration of care, the information communication, and education, physical comfort, emotional support, involvement of family and friends. Now, from that, we're moving to the next level, which is really called engaged care, and this is an article that came out in 2017 by Frampton et al. And, it's really care that's planned, delivered, managed and continuously improved in active partnership with patients and their families to ensure integration of their health and health care goals, preferences, and values. And, some key words here are active partnership and ensuring integration. Patient engagement has many definitions but key concepts include patients are involved in their care, they decide how best to fit care into their lives, and patients take action to get the greatest benefit from their care. Now, there are some challenges in patient engagement. There's health literacy. So, you may find that patients that have low health literacy may have more trouble engaging in their care. So, thinking about making education available to their reading and literacy level is quite important here. Cultural competence. Socioeconomic factors, so, sometimes it's harder for patients to engage in the wellness activities that they may want to because of cost. Willingness to be engaged, some patients don't choose to be engaged, they still want the physician to tell them or the health care providers to tell them what to do, and, we have to be respectful of that. And then, cognitive issues. For some patients, it's very difficult to understand all of the choices and the ramifications. This is a slide that shows you the different levels of engagement, both at direct care levels as well as at the organizational and policy making. And, this came out of a health policy briefing in 2013 and is a good tool to look at as you're trying to move from a consultative to a very engaged partnership. Patient activation was written by Hibbard in 2013, and that's really the next level. Understanding one's role in the care process and having the knowledge, skills, and confidence to take on that role. And, there are many different tools to look at for how activated your patients are or opportunities to create greater activation based on their skill levels, their health literacy, their cognitive abilities, all the things that we talked about in patient engagement. So, does it make a difference? Well, Health Affairs article cites the following things. That patients that are engaged have a 5.3% lower medical costs and this is involved when you get them into decision making support, shared decision making. They have 12.5% fewer hospital admissions and 21% fewer preference sensitive heart surgery. So again, when people look at does engaging your patients, activating your patients make a difference? This is some data that shows that it does.
