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Visits to the doctor are a vital part of health care and disease management, but what patients do on their own in between those appointments is equally, if not more, important.
“A patient’s health depends so much on what happens once they leave the doctor’s office—how they make decisions about their health behaviors, whether they have the right information when they need it most, how involved they feel in their care and their ability to self-manage their medical problems,” said Adam Licurse, MD, a primary care physician at South Huntington Advanced Primary Care Associates at BWH. “We need to give patients more touch points with us in between visits, better information about the care they’re receiving and more opportunities to be engaged in their health care when they’re at home.”
Many studies have proven that people have better health outcomes at lower costs—and better care experiences—if they are more engaged in their own care. The Brigham and Women’s Physicians Organization (BWPO) has made patient engagement a key component of its population health management strategy, with a focus on new tools and programs that will encourage patients to take an active role in their health.
A Visual Prescription
One effort that has already seen success is Vidscrips. This online video software program allows clinicians and other staff to easily record short informative video “prescriptions” that are specific to certain diseases, such as diabetes and hypertension, or populations, such as pregnant women. Patients are able to watch the videos whenever they have questions related to their condition or information their clinician has shared.
“There is a lot of useful information we give patients when they come to the office: how to request new medications, when to call us instead of going to the emergency room, how to manage their back pain or how to safely take their medications,” said Licurse, noting that patients traditionally receive information verbally or in the form of printed handouts, which are sometimes lost after the visit. “But how much of it is actually retained? And do they remember the critical details when they are back at home or discussing their last visit with a family member or caregiver?”
Since Vidscrips launched at South Huntington earlier this year, Licurse has prescribed his videos about 50 times, and they have been viewed more than 400 times. In addition to Primary Care, Vidscrips is also engaging pregnant patients by providing information to answer questions between visits, and in Neurosurgery by delivering better instructions for post-operative and post-discharge care.
In addition to Vidscrips, the BWPO is also implementing another visual tool: virtual visits where patients can safely be seen without coming to their doctor’s office. “These visits let patients remotely see and talk with a doctor, physician assistant or nurse practitioner,” said Licurse, adding that Endocrinology, Cardiology, Dermatology and Psychiatry are other areas where virtual visits may be appropriate for some patient populations.
Outcomes That Matter to Patients
Another important initiative to increase patient engagement is a widespread campaign to measure outcomes as reported by patients, in addition to those assessed by physicians or health systems. Outcomes that matter to patients include such things as whether the patient can climb up a flight of stairs without feeling pain, lie down without becoming short of breath or feel well enough to go out and socialize.
“Asking patients to share information related to these types of outcomes is equally important to collecting data on more traditional outcomes, such as mortality, adverse events and readmissions,” Licurse said.
The collection of PROMS, or patient-reported outcomes measures, rolled out across Partners in 2012 and has since rapidly spread. Patients answer a series of questions on an iPad in the waiting room at the clinic and then receive follow-up questionnaires at pre-determined intervals. Today, Partners is a national leader in PROMs work, and BWH is leading the system with thousands of surveys completed by patients over the past year across seven departments, and more joining the effort each month.
In addition to a number of disease-specific PROMs, the BWPO is measuring patient engagement directly in four departments, using a PROM called the Patient Activation Measure, which assesses a patient’s ability to self-care and other key determinants of active health involvement. This measure will provide new insights into patient behavior and will allow for better tailoring of care to specific patient groups.
Connecting Patients
BWH is also leading the way on another Partners-wide effort to increase patient engagement with the use of “Patients Like Me,” an online community that allows patients to connect with others who have the same disease and share information about their symptoms and care experience. “We are setting up a link from Patient Gateway that will enable patients with certain problems to easily join a community within Patients Like Me that is relevant to them, so they can learn from other patients who have shared experiences and hopefully teach back their own lessons along the way,” Licurse said.
If you are interested in learning more about these programs, email alicurse@partners.org.