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blueshieldcafoundation.org Feb. 25, 2013 connectedness and continuity: a prescription for patient engagement Institute of Medicine Roundtable on Value & Science-Driven Health Care Washington, DC. Presenter: Gary Langer Langer Research Associates [email protected]

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Page 1: connectedness and continuity: a prescription for patient … · 2019-05-21 · blueshieldcafoundation.org Feb. 25, 2013 connectedness and continuity: a prescription for patient engagement

blueshieldcafoundation.org Feb. 25, 2013

connectedness and continuity:

a prescription for patient engagement

Institute of Medicine

Roundtable on Value & Science-Driven Health Care

Washington, DC.

Presenter: Gary Langer

Langer Research Associates

[email protected]

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BSCF research program

changing health care paradigm for low-income Californians

• ACA introduces competition; providers will need to respond

spring 2011: baseline survey of healthcare experiences and preferences

• establish drivers of patient loyalty

two drill-downs emerge:

• expressed desire for a regular personal doctor

• substantial resistance to shared decision making

spring 2012: explore these and other potential drivers of patient empowerment and engagement

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connectedness and continuity

What patients say they want…

… a regular personal doctor

What patients mean they want…

….connectedness (a sense someone there “knows you pretty well”)

…and continuity (an assurance you’ll see the same caregiver over time)

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the impact

Wanting but lacking a personal doctor independently (negatively) predicts

satisfaction with care and patient loyalty…

But when connectedness and continuity are added to the equation, they independently (positively) predict satisfaction, empowerment and engagement alike – and having a regular personal doctor does not

page 4

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shared decision making

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shared decision making

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leveling the playing field preference for an equal say

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the path to patient-centered care: a model of empowerment and

engagement

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confident you can make healthcare

decisions

provider usually explains things in

a way you understand

comfortable asking

provider questions

feel informed about your health

a model of patient engagement

based on results from the 2012 BSCF survey of low-income Californians

page 9

connectedness

continuity

engagement

empowerment:

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connectedness and information

page 10

connectedness

continuity

engagement

comfortable asking

provider questions

provider usually explains things in

a way you understand

confident you can make healthcare

decisions

feel informed about your health

empowerment:

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the impact of connectedness on feeling informed about one’s health

among low-income Californians

with a personal connection

among low-income Californians

who lack a personal connection

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continuity and information

page 12

connectedness

continuity

engagement

comfortable asking

provider questions

provider usually explains things in

a way you understand

confident you can make healthcare

decisions

feel informed about your health

Empowerment:

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the impact of continuity on feeling informed about one’s health

among those who usually see

the same provider

among those who see the

same provider less often

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connectedness and further empowerment

page 14

connectedness

continuity

engagement

comfortable asking

provider questions

provider usually explains things in

a way you understand

confident you can make healthcare

decisions

feel informed about your health

empowerment:

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the impact of connectedness on further empowerment measures

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continuity and further empowerment

page 16

connectedness

continuity

engagement

comfortable asking

provider questions

provider usually explains things in

a way you understand

confident you can make healthcare

decisions

feel informed about your health

empowerment:

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the impact of continuity on further empowerment measures

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the importance of information

page 18

connectedness

continuity

engagement

comfortable asking

provider questions

provider usually explains things in

a way you understand

confident you can make healthcare

decisions

feel informed about your health

empowerment:

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the impact of information on other empowerment measures

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empowerment and engagement

page 20

connectedness

continuity

engagement

comfortable asking

provider questions

provider usually explains things in

a way you understand

confident you can make healthcare

decisions

feel informed about your health

empowerment:

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empowerment and engagement % who report having a great deal of say in their care

yes yes yes yes no no no no

very informed? very comfortable

asking questions?

always understand

provider?

very confident

can make HC

decisions?

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one route: team-based care

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58% 56%52%

47% 46%42%

satisfaction with

care

very informed about

health

always understand

providers' instructions

among those who have team-based care

among those who do not have team-based care

the impact of team-based care

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48%

35%

have someone who knows you well

among those who have team-based care

among those who do not haveteam-based care

team care II

51% 51%

32%

have someone who knows you well

private doctors' office patients overall

clinic patients with team-based care

clinic patients who lack team-based care

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Rx for patient engagement

connectedness and continuity pave the path to patient empowerment and

engagement

information is essential;

• it predicts self-efficacy even when connectedness and continuity are held

constant

• …and it does so more strongly than education, income, gender, race and other

demographic variables

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and a word on measurement (inspired by our literature reviews)

• attitudinal measurements in non-probability samples are not generalizable

• aapor task force report (2010)

• agree/disagree and yes/no questions are inherently biasing

• Saris et al., Survey Research Methods (2010) 4/1: 61-79

• unlabeled or partially labeled number scales often lack internal validity

• Krosnick & Fabrigar, Sociological Methods & Research (2009) 37: 393-425

• knowledge is problematic to measure in an opinion survey format

• challenges are cognitive, measurement-based and definitional

• data analysis is enriched by rigorous statistical modeling

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thank you!

Institute of Medicine

Roundtable on Value & Science-Driven Health Care

Washington, DC.

Presenter: Gary Langer

Langer Research Associates

[email protected]