Patient Engagement in the Process of Planning and Designing Outpatient Care Improvements at the Veterans Administration Health-care System

Findings from an Online Expert Panel

Published in: Health Expectations, 2016

Posted on RAND.org on March 02, 2016

by Dmitry Khodyakov, Susan Stockdale, Nina Smith, Marika Booth, Lisa Altman, Lisa V. Rubenstein

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This article was published outside of RAND. The full text of the article can be found at the link above.

Research Questions

  1. What are the best ways for the Veterans Administration (VA) health care system to get patients involved in their own care, and to help the VA plan and design outpatient care?
  2. Which patient engagement approaches can help improve care quality?

CONTEXT: There is a strong interest in the Veterans Administration (VA) Health-care System in promoting patient engagement to improve patient care. METHODS: We solicited expert opinion using an online expert panel system with a modified Delphi structure called ExpertLens™. Experts reviewed, rated and discussed eight scenarios, representing four patient engagement roles in designing and improving VA outpatient care (consultant, implementation advisor, equal stakeholder and lead stakeholder) and two VA levels (local and regional). Rating criteria included desirability, feasibility, patient ability, physician/staff acceptance and impact on patient-centredness and care quality. Data were analysed using the RAND/UCLA Appropriateness Method for determining consensus. FINDINGS: Experts rated consulting with patients at the local level as the most desirable and feasible patient engagement approach. Engagement at the local level was considered more desirable than engagement at the regional level. Being an equal stakeholder at the local level received the highest ratings on the patient-centredness and health-care quality criteria. CONCLUSIONS: Our findings illustrate expert opinion about different approaches to patient engagement and highlight the benefits and challenges posed by each. Although experts rated local consultations with patients on an as-needed basis as most desirable and feasible, they rated being an equal stakeholder at the local level as having the highest potential impact on patient-centredness and care quality. This result highlights a perceived discrepancy between what is most desirable and what is potentially most effective, but suggests that routine local engagement of patients as equal stakeholders may be a desirable first step for promoting high-quality, patient-centred care.

Key Findings

  • Getting patient feedback in the process of making care planning and design decisions at local VA clinics and hospitals is both feasible and desirable.
  • Engagement at the local, rather than regional, level can help patients envision effects of changes in their care.
  • Equal partnerships between patients and providers at the local level could help improve patient-centeredness of VA care.
  • Building patient engagement capacity will be an ongoing process; education, best practices, and rewards for successful engagement efforts may be needed along the way.
  • Offering multiple patient engagement opportunities may help patients choose the one that best fits their preferences and skills.

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