New Article Details How Patient Engagement Provides Enhancements To Health Care Delivery System

Featured in December 2014 issue of The Joint Commission Journal on Quality and Patient Safety

Patient engagement in practice improvement projects resulted in enhancements to the health care delivery system at University of Wisconsin (UW) Health, Madison, Wisconsin, as well as provided unique and essential contributions, according to an article, “Engaging Patients at the Front Lines of Primary Care Redesign: Operational Lessons for an Effective Program,” in the December 2014 issue of The Joint Commission Journal on Quality and Patient Safety.

Current national health care policy and local market pressures are encouraging organizations to partner with patients in an effort to improve the value of the health care delivery system. From 2009 to 2014 at UW Health, 47 teams engaged patients in practice improvement projects. William Caplan, M.D., and co-authors studied the improvement projects and identified five key components for fostering a culture of patient engagement:

• Alignment of the organization’s vision with the redesign of national health care priorities. Patient engagement was identified as a priority with the goal of improving health care.
• Readily available external experts. The Center for Patient Partnerships provided expertise and knowledge, and offered consultation with system leaders, and training for frontline care teams and improvement coaches.
• Involvement of all care team members in patient engagement. Microsystem training engaged providers and staff with a less physician-centric approach that allowed the whole team to participate in improvements.
• Integration within an existing continuous improvement team development program. The microsystem curriculum provided a pre-existing program that was readily expanded to include patient engagement training.
• Intervention deliberately matched to organizational readiness. Strategically deploying engagement interventions that matched organizational readiness.

These components led not only to higher levels of patient engagement (as defined in a framework of five progressive levels) but also to positive feedback from staff and providers about the program and patients’ participation.

In an accompanying editorial, “Moving Patients from Consultants to Partners in Health Care System Redesign: Achieving Meaningful Engagement,” Grace A. Lin, M.D., M.A.S., and Naomi S. Bardach, M.D., M.A.S., University of California, San Francisco, suggest that several lessons can be learned from the UW Health experi­ence. For example, the five-level framework can help both categorize existing programs of patient engagement and serve as a guide toward achieving higher levels of patient involvement. Also, setting an expectation of greater patient engagement (including, at a minimum, discussion of quality improvement initiatives), coupled with training and organizational support, can lead to the successful integration of patients into quality improvement processes.

The remaining articles from the December 2014 issue are:

Organizational Leadership
Strategies for Aligning Physicians to System Redesign Goals at Eight Safety-Net Systems
Leah Zallman, M.D., M.P.H.; Adriana Bearse, M.S.; Natasha Neal, M.P.H.; Carol VanDeusen Lukas, Ed.D.; Karen Hacker, M.D., M.P.H.

Aligning physicians with system redesign goals is a priority for safety-net systems (SNSs), particularly with the shift toward patient-centered, population health–focused models. In a qualitative study, physician role definition and organizational infrastructure strategies to address challenges facing the SNSs were identified. The findings suggest that physician alignment to strategic redesign priorities at all health systems, whether SNSs or not, is a complicated process that requires a multifaceted approach.

Coordination of Care
Excellence in Transitional Care of Older Adults and Pay-for-Performance: Perspectives of Health Care Professionals
Alicia I. Arbaje, M.D., M.P.H.; Alison R. Newcomer, M.H.S.; Kenric A. Maynor, M.D., M.P.H.; Robert L. Duhaney, M.D.; Kathryn J. Eubank, M.D.; Joseph A. Carrese, M.D., M.P.H.

Care transitions for older adults (65 years and older) across health care settings can result in adverse outcomes. Interviews conducted with 20 health care professionals with direct experience in such care transitions suggested components and markers of effective transitional care, difficulties in design and implementation of pay-for-performance strategies, and concerns and unmet needs related to delivering optimal care during transitions.

Case Study in Brief
Reducing Central Line–Associated Bloodstream Infections in Three ICUs at a Tertiary Care Hospital in the United Arab Emirates
Kalpana K. Reddy, M.B.B.S., FRCA; Asha Samuel, B.S.N., M.S.N.; Kathleen Ann Smiley, B.S.N.; Stefan Weber, M.B.B.S., M.D.; Hubert Hon, M.B.B.Ch., FC Paed(SA), Crit Care

A multistage quality improvement project was conducted to decrease central line–associated bloodstream infection (CLABSI) rates at a tertiary care hospital. Overall CLABSI rates decreased by 51 percent (p < .0001) from a mean of 2.99 (standard deviation [SD], 1.69) in the pre-implementation period (January 2008–June 2011) to 1.47 (SD, 1.01) in the post-implementation period (July 2011–August 2014).

Rapid Response Systems
An Assessment of Critical Care Interventions and Resource Utilization During Medical Emergency Team Activations in Nonhospitalized Patients
Matthew P. Gilman, M.D.; Yuxiu Lei, Ph.D.; Timothy N. Liesching, M.D.; James M. Dargin, M.D.

Little is known about medical emergency team (MET) interventions and resource utilization during activations for non-hospitalized patients. In a retrospective analysis of consecutive MET activations in adults during a two-year period at a tertiary care center, non-hospitalized patients accounted for 28 percent of all activations. The majority (65 percent) of these patients required no intervention, and few (4 percent) required critical care. Non-hospitalized patients in “high-risk” areas where outpatient invasive procedures are frequently performed were most likely (19 percent) to require critical care interventions. MET activations in non-hospitalized patients do not require the same resource-intense response as inpatient activations, and a “ramp-up” model of staffing may be appropriate in most cases.

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