Home Care Technology Report

Engaging Patients: A Challenging New Frontier in Healthcare Delivery

By Audrey Kinsella

Patient engagement is an experience, an expectation and a goal. Persons with chronic conditions, especially in this era of accountable care, reach for the goal as they experience care at the hands of professionals, from whom they expect quality interactions.

Patient engagement is a goal at the Center for Connected Health, housed within Partners Healthcare in Boston. We spoke with CCH founder and director Joseph C. Kvedar, MD about a January posting on his blog titled "Engagement is the Next Frontier of Connected Health," in which he described how CCH is approaching this frontier territory. He expanded on his article for us, offering key pointers for getting patients engaged.

Step 1 Self-Management

Obtaining patient engagement is a multi-layered process at CCH, Kvedar told us. The first step is to encourage patients to self-track their chronic condition management routines via tele-tools. Anyone can do this with a smart phone or tablet, he believes, but engagement does not end with tracking. In addition to simply following these routines, patients need to understand the long-term requirements of self-managing their health. Self-tracking is a prerequisite, Kvedar insists, not patient engagement itself.

Step 2 Feedback Loop

That is why the next step is key. CCH has clinicians connecting in a timely fashion to their patients via a "feedback loop." Through this patient-clinician-patient communications loop, clinicians can provide targeted information that, Kvedar says, helps keep health at the top of patients' minds. He reports that feedback loops "work incredibly well to establish the awareness needed to change a person's mindset about health."

Nevertheless, there is a glitch to this method of supporting patients' long-term self management activities. Patients often develop a malaise toward performing self-management routines and reporting findings. Therefore, CCH has developed...

Step 3 Eschewing Ennui

Psychologists call it "habituation." Kvedar describes it as routine fatigue. "Once people get used to something, they tend to get bored with it and move onto something else." Hence, a challenge to CCH clinicians and researchers became not "How do we get people engaged?" but "How do we keep people maximally engaged and responsive to their health data?"

Kvedar acknowledges that the solution to this question can be complicated. There is no one way to correct this digression because, he says, "Everyone is wired differently; everyone responds to different motivators." He suggests developing customized, targeted information and goals for each patient in order to maintain engagement or re-engage disconnected patients.

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Do not look to him, however, for a cookie-cutter program. He means exactly what he says when he uses words like "customized" and "targeted." Creating the right materials for each patient, ones that will will be used regularly, is an exciting concern for CCH staff. "If we could learn enough about what motivates you to develop and send individualized, engaging messages that make your personal health data relevant, we could achieve real, sustained behavior change."

He finds it complicated because the answer lies not only in what should be said, but how it should be conveyed to each patient throughout the course of their care. "Messages should change over time as a person grows and changes throughout their quest for improved health."

"We're not there yet," he admits. "We do not understand exactly how to motivate patients to be engaged with their healthcare routines over the long term. What we do know is, following all three of these steps is vital for for obtaining patient engagement. Feedback loops plus varied contextual messaging are much more powerful than feedback loops alone."

Essentially, what CCH is developing is a clinician-assisted, self-management protocol for persons with chronic conditions, designed to get and keep patients engaged. It is a partnership approach for this accountable care era.

Kvedar concludes: "We have shown that sharing personal health data with your clinician creates context, which leads to improved patient adherence. If patients know that their healthcare provider is watching, they are more prone to stick to their plan and make healthier choices. This, in a nutshell, is the promise of connected health."

Audrey Kinsella, MA, MS, has written on home telehealthcare and new technologies for home care service delivery for 20 years, in 6 books, multiple web sites, and more than 150 published articles. She can be reached at: telehealthcare@lycos.com or 828-505-2285.

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2012 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan's Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com