WHAT IS PATIENT ENGAGEMENT?

Patient engagement is the process by which patients become invested in their own health. Health systems with effective patient engagement programs provide patients with the information and tools needed to take control of their care. From Meaningful Use to Accountable Care Organizations, patient engagement is a key feature of payment reform. Achieving excellence in clinical outcomes is dependent upon superior patient engagement.

WHY A PATIENT ENGAGEMENT RANKING?

For nearly a quarter century, US News and World Report has produced its popular hospital rankings, but these reports do not specifically call out patient engagement. In fact, Axial has confirmed that the US News rankings do not include patient satisfaction. Why does it matter what patients think? Because patients are consumers. Over the last 15 years, consumers have begun to rely on each other for advice for everything from restaurants and hotels to lawyers and professors. Consumerization in healthcare is driven not only by the transparency brought about by the internet, but also by rising deductibles and a boom in patient engagement. Finally, patient engagement is increasingly at the center of health reform as highlighted by the Patient Engagement Framework from ONC and the eHealth Collaborative.

METHODOLOGY

I. Readmissions (25%)

Definition:

This category is based on response from public patient satisfaction data collected by Centers for Medicare and Medicaid (CMS) that is available at www.medicare.gov/hospitalcompare. The measures posted on the Hospital Compare site represent the consensus of CMS, The Joint Commission (TJC), the National Quality Forum (NQF), and the Agency for Healthcare Research and Quality (AHRQ). The information on Hospital Compare is meant to inform healthcare consumers and to encourage hospitals to improve the quality of care they provide. Readmissions data are collected from Medicare enrollment and claims data as well as from the Centers for Disease Control and Prevention (CDC) via the National Healthcare Safety Network (NHSN).

Rationale

Depending on the diagnosis, between 5% and 30% of adults are readmitted after a hospital admission. Roughly one quarter of Medicare expenditures for inpatient care are for readmissions. To that end, the Centers for Medicare and Medicaid Services lists them among its key outcomes measures. QualityNet.org elaborates further:

The Centers for Medicare & Medicaid Services (CMS) 30-day readmission measures assess a broad set of healthcare activities that affect patients’ well-being. Patients who receive high-quality care during their hospitalizations and their transition to the outpatient setting will likely have improved outcomes, such as survival, functional ability, and quality of life.

The public reporting of 30-day risk-standardized readmission measures is consistent with the priorities of the Department of Health and Human Services’ National Quality Strategy, which aims to: a) improve healthcare quality; b) improve the health of the U.S. population; and c) reduce the costs of health care.

Supporting Research:

Keenan PS, Normand SL, Lin Z, et al. “An administrative claims measure suitable for profiling hospital performance on the basis of 30-day all-cause readmission rates among patients with heart failure,” Circ Cardiovasc Qual Outcomes. 2008 Sep;1(1):29-37

Lindenauer PK, Normand SL, Drye EE, Lin Z, et al. “Development, validation, and results of a measure of 30-day readmission following hospitalization for pneumonia,” J Hosp Med. 2011 Mar;6(3):142-50. doi: 10.1002/jhm.890. Epub 2011 Jan 5.

II. Patient satisfaction (25%)

Definition:

This category is also based on response from public patient satisfaction data collected by Centers for Medicare and Medicaid (CMS) that is available at www.medicare.gov/hospitalcompare. The survey is called the Hospital Consumer Assessment of Health Plans Survey (HCAHPS). The intent of the HCAHPS initiative is to provide a standardized survey instrument and data collection methodology for measuring patients' perspectives on hospital care. The points awarded in this category are directly driven by HCAHPS performance.

Rationale

In May 2005, the National Quality Forum (NQF), an organization established to standardize health care quality measurement and reporting, formally endorsed HCAHPS. The NQF endorsement represents the consensus of many health care providers, consumer groups, professional associations, purchasers, federal agencies, and research and quality organizations. According to one study, higher patient satisfaction via the HCAHPS survey is associated with improved guideline adherence and lower inpatient mortality rates.

Supporting Research:

Glickman SW, Boulding W, Manary M et al. "Patient satisfaction and its relationship with clinical quality and inpatient mortality in acute myocardial infarction," Circ Cardovasc Qual Outcomes 2010;3:188–95.

Boulding, W., Glickman, S.W., Schulman, K.A., and Staelin, R., “Relationship Between Patient Satisfaction With Inpatient Care and Hospital Readmission Within 30 Days,” American Journal of Managed Care, 2011 Jan: 17 (1): 41-48.

III. Patient education and self care tools (25%)

Definition:

Health systems support patient education and self care by providing patients with information and tools needed for self care such as patient portals and electronic libraries of health content. Maximum points are awarded to health systems that not only offer electronic access to patient health records, but also provide resources needed for the day-to-day management of disease. The best health systems offered these tools via the device of the patient's choice: desktop, tablet, and mobile. This information was gathered from publicly available websites and mobile applications.

Rationale

Resources for health management are the cornerstone of patient engagement. How can patients engage in their health care without the information to understand what is going on with their health and the tools to manage progress against health goals?

Supporting Research:

Hibbard, J.H, Greene, J. and Overton, V., “Patients With Lower Activation Associated With Higher Costs; Delivery Systems Should Know Their Patients’ ‘Scores,’” Health Affairs, Feb 2013: 32 (2):216-222.

Karman, K.L. et al., “Patient and Family Engagement: A Framework for Understanding The Elements and Developing Interventions and Policies,” Health Affairs, February 2012: 32 (2), 222-231.

R. Jay Widmer, M.D., Ph.D, “Mayo Research Shows Cardiac Rehab Patients Who Use Smartphone App Recover Better” Mayo Clinic News Network, March 29, 2014

Carter MC, Burley VJ, Nykjaer C, Cade JE, “Adherence to a smartphone application for weight loss compared to website and paper diary: pilot randomized controlled trial” J Med Internet Res. 2013 April 15; 15(4):e21

IV. Social media engagement (25%)

Definition:

Social engagement is the extent to which health systems engage with their communities via social networking channels. Maximum points are awarded to health systems that not only have a social media presence, but also have engaged a relatively large audience that expresses positive sentiment towards the health system.

Rationale:

Two recent studies have underscored the importance of hospital’s social media engagement with overall patient satisfaction and quality. Commercial websites that post consumer ratings of businesses are popular. Facebook and Twitter are among the top 10 most popular websites in the USA. By contrast, only 6% of Americans have heard of the US Centers for Medicaid and Medicare Services’ (CMS) national hospital public reporting website, hospitalcompare.hhs.gov. One study showed a positive correlation between Facebook likes and care quality and patient satisfaction.

Supporting Research:

Bardach, N.S., et al., “The Relationship Between Commercial Website Ratings and Traditional Hospital Performance Measures in the USA,” BMJ Quality & Safety, 2013. 2-“194-202 doi:10.1136/bmjqs-2012-001360

Boulding, W., Glickman, S.W., Schulman, K.A., and Staelin, R., “Relationship Between Patient Satisfaction With Inpatient Care and Hospital Readmission Within 30 Days,” American Journal of Managed Care, 2011 Jan: 17 (1): 41-48.

Timian, A. and Kachnowski, S., “Do Patients ‘Like’ Good Care? Measuring Hospital Quality via Facebook,” American Journal of Medical Quality, February 2013, 10.1177/1062860612474839