Humans are social animals, and providers can use those social connections as a driving force for better patient engagement.
Peer support and coaching programs can lead to better care management for patients with chronic conditions, for example, said David A. Asch, M.D., executive director of Penn Medicine Center for Health Care Innovation, and Michele E. Heisler, M.D., professor of internal medicine and health behavior at the University of Michigan, during an event hosted by NEJM Catalyst.
Heisler said providers should be able to access these programs through a “menu of options” at any time to connect with different patient populations. These strategies, she said, will also be helpful as the healthcare industry is now in a large web of groups that want to improve health and quality of life for people.
“A doctor just isn’t around during all those every day times when important health choices are made,” Asch said.
Heisler said that research has found that peer supports are particularly effective for patients with diseases like diabetes. The programs benefit both trained coaches and patients; for example, a diabetic coach who warns a peer about sugar intake is less likely to turn around and eat something unhealthy, she said. And though the coaching and support can take a bit of the burden off doctors and nurses, she said the programs should not be designed to totally eliminate the clinician role in patient monitoring.
Peer support programs also have a positive impact on one of the major social determinants of health: loneliness, she said. People want to feel useful and being sick exacerbates a feeling of uselessness.
But these programs need buy-in from physicians as well, because peer support teams require training and a connection with the system to work effectively. Asch said that providers should look at social incentives like a ladder, and as patients climb that ladder they are more engaged in social activities that improve their health. This allows providers and other stakeholders to make health interventions a little more fun for patients, too, he said.
Looking at social behaviors doesn’t extend only to patients, either. Clinicians and other healthcare stakeholders can look at how their care teams interact to improve both patient engagement and the effectiveness of team-based care.
Team-based care in action
Nirav Shah, M.D., senior vice president and chief operating officer for clinical operations at Kaiser Permanente Southern California, outlined the ideal, coordinated and team-based patient experience: the “zero day stay.” A patient undergoes a hip replacement and is discharged immediately to recover at home. However, this approach requires a nurse or other member of the clinical team to visit the patient’s home in advance to make recovery easier. For example, during that home visit, they may remove a rug the patient could trip on or move a bed to a more accessible location.
Once the patient is discharged home, the surgeon calls and checks in before bed. Physical therapy sessions occur in the patient’s home. But a program like this, he said, requires trust and confidence between each member of the care team to succeed.
“It’s a flat hierarchy where team members are all responsible for ensuring safety,” he said.
In addition, he said, the group can customize the program so it is more tailored to the needs of the patient, which will make the experience more satisfying.
To improve first standardize to the height of evidence-based medicine then customize to patient uniqueness. Nirav Shah, MD #PatientEngage17— David E. Womack (@DavidEWomack) April 13, 2017
Care teams for complex patients
Though not every patient may be a candidate for something like a “zero day stay,” the most vulnerable and sick patients also benefit from care teams that work together effectively and where all members are engaged in the process and with patients, said Toyin Ayaji, M.D., chief medical officer of Commonwealth Care Alliance, an integrated delivery network that treats dual-eligibility patients almost exclusively.
The complex needs of these patients often extend beyond mere healthcare, she said, and differing goals can sometimes put them at odds with clinical teams. For some patients, team-based care can feel like two teams: the clinical team and the patient on his or her own, she said. So providers and other stakeholders must understand the goals of patients with complex conditions; for instance, the ultimate clinical goal may be to reduce A1C levels in a diabetic patient, but the team must address the patient's housing insecurity first.
Patients should be empowered to be a member of the care team as well, Ayaji said, and providers must prioritize shared goals, even if ultimately they’re not the most clinically important. A patient must be able to connect with at least one member of the care team, even if that person isn’t a clinician, who can serve as an advocate in care discussions.
The ultimate goal for both team-based approaches is an improved clinical outcome, she said, but for the sickest patients, providers and other stakeholders may be required to take the “scenic” route to the clinical goals.