Using Electronic Health Record Portals to Improve Patient Engagement: Research Priorities and Best Practices.

Ninety percent of health care systems now offer patient portals to access electronic health records (EHRs) in the United States, but only 15% to 30% of patients use these platforms. Using PubMed, the authors identified 53 studies published from September 2013 to June 2019 that informed best practices and priorities for future research on patient engagement with EHR data through patient portals, These studies mostly involved outpatient settings and fell into 3 major categories: interventions to increase use of patient portals, usability testing of portal interfaces, and documentation of patient and clinician barriers to portal use. Interventions that used one-on-one patient training were associated with the highest portal use. Patients with limited health or digital literacy faced challenges to portal use. Clinicians reported a lack of workflows to support patient use of portals in routine practice. These studies suggest that achieving higher rates of patient engagement through EHR portals will require paying more attention to the needs of diverse patients and systematically measuring usability as well as scope of content. Future work should incorporate implementation science approaches and directly address the key role of clinicians and staff in promoting portal use.

Strengthening patient and family engagement in healthcare - The New Haven Recommendations.

OBJECTIVE: Present and discuss the development and basic structure of a multilevel approach to strengthen patient and family engaged care, "The New Haven Recommendations on partnering with patients, families and citizens to enhance performance and quality in health promoting hospitals and health services". METHODS: A generic literature review was conducted followed by a Delphi procedure to prepare the New Haven Recommendations. From systems theory perspective, three conceptual levels are used to map action areas to enhance patient and family engaged care. RESULTS: The recommendations propose a multilevel approach to enable patient, family, (and citizen representatives') involvement (a) within direct service provision; (b) among hospitals and health services; (c) in planning healthcare delivery systems and policy. CONCLUSION: The New Haven Recommendations provide a strategic tool and practical recommendations, which can be used for reflection on current practices or generating new ways of thinking about patient and family engaged care. They support the development of patient and family engaged care as core aspect of high quality healthcare, and can contribute to achieving the Ottawa Charter's claim of reorienting health services. PRACTICE IMPLICATIONS: The potential benefit of the multilevel approach is to reorient the basic culture of healthcare towards patient- and health-centered care.

Using patient-reported outcome measurement to improve patient care.

Patients at the center of care is often the stated focus of clinicians and healthcare services. The quality and safety movement has shown that effective organization of care is needed, in addition to professional skills. This movement has provided professionals and others with methods to improve both organization and practice for patients. These methods include measurement to give those carrying out improvement feedback about the effects of their changes. New types of measures that enable patients to report treatment outcomes can now be use in quality improvement and quality reporting to bring a renewed focus on making care more patient-centered. Although used for some time in research, these measures are relatively new tools for quality improvement and not all research measures are suitable for everyday feedback or improvement projects. The purpose of the paper is to provide an introduction to the use and value of patient-reported outcome measures in quality improvement and to give practical guidance and resources for using PROMs for quality improvement. It draws on the authors' experiences using patient reported outcomes measures for quality research and improvement and their workshop at the 2016 Tokyo ISQUA conference, as well as on reviews and guidance documents about the use of PROMs. It does not provide a comprehensive and systematic review of research, but an overview and introduction to PROMs for quality improvement.

Resident-Centered Care in 10 U.S. Nursing Homes: Residents' Perspectives.

PURPOSE: With increased focus on resident-centered care (RCC) as an organizational imperative and a guiding principle of culture change for long-term care communities, evaluation of its success has centered primarily on the organizational perspective. METHODS: For this case report, we examine resident perspectives of RCC in 10 nursing homes across the United States that had adopted RCC as a philosophy and model of care for at least 12 months with a maximum engagement of 3 years using a phenomenological approach. FINDINGS: Qualitative findings from 20 focus groups with residents in 10 nursing homes suggest that RCC has meaning in ways that are consistent with intentions at the national and state levels to advance culture change in nursing homes, including efforts to create a more homelike environment, increase resident decision making and direction of his or her lifestyle, and put residents first. CLINICAL RELEVANCE: Residents attribute increased choice in wake and bed times, being heard by organizational leaders, and consistent staff assignment as positive changes since RCC began. However, according to residents, aspects of institutional life in nursing homes, inconsistent with RCC, remain. Residents identified three areas of improvement that would make nursing homes more resident centered. The three areas are response time, access to nature, and transparency about illness and death in the community.

Compassion as the foundation of patient-centered care: the importance of compassion in action.

The Institute of Medicine defines patient-centered care as "providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions." What is missing in this definition is an explicit emphasis on compassion. This perspective article draws on the experience of Planetree (CT, USA), a not-for-profit organization that partners with healthcare establishments to drive adoption of patient-centered care principles and practices by connecting healthcare professionals with the voices and perspectives of the patients and family members who utilize their services. Across hundreds of focus groups facilitated by Planetree, patients and their loved ones emphasize that paramount among their needs, preferences and values are compassionate human interactions. For care to be truly patient-centered, a foundation of compassion is essential. Reports from patients and the media, and research from healthcare systems around the world demonstrate the fallacy of assuming that compassion is a current or prevalent feature of the care experience. Concurrently, a growing evidence base highlights the supreme importance of compassion in driving high-quality, high-value care. However, good intentions are not sufficient for delivering compassionate care. Drawing on the experiences of exemplary patient-centered hospitals (recognized as such following a rigorous culture audit to determine fulfillment of the criteria for formal recognition as a Designated® Patient-Centered Hospital [Planetree]), this paper explores practical approaches for embedding compassion in healthcare delivery and organizational culture to meet patients' expressed desires for empathic and respectful human interactions.

Partnering with families.

Those who know the patient best can help bridge the gap between hospital and home.

Holistic Care in the US Military I-The Epidaurus Project: An Initiative in Holistic Medicine for the Military Health System, 2001-2012.

This article describes the history and findings of the Epidaurus Project, a Uniformed Services University-affiliated project to bring holistic care and evidence-based design into the Military Health System (MHS). A distinguished group of civilian thought leaders contributed. The 2005 Base Realignment and Closure process offered a chance to implement the Epidaurus agenda. A new integrated healthcare delivery system, centered around the Walter Reed National Military Medical Center at Bethesda, Maryland, was the result. These facilities will be templates for a new generation of MHS "healing environments" and a model for innovative systems of healthcare nationwide. The Epidaurus Project represents a significant collaboration between civilian medicine and the military in times of war.

Este artículo describe la historia y los hallazgos del Proyecto Epidaurus, un proyecto en colaboración con la Uniformed Services University (Universidad de Servicios Uniformados), para incorporar la medicina holística y el diseño basado en la evidencia en el Military Health System (Sistema de Salud Militar). A ello contribuyó un grupo distinguido de líderes intelectuales civiles. El proceso de Realineamiento y Cierre de Bases del 2005 ofreció una oportunidad para implementar el programa Epidaurus. El resultado fue un sistema nuevo e integrado de asistencia sanitaria, centrado alrededor del Walter Reed National Military Medical Center de Bethesda. Estas instalaciones serán el modelo para una nueva generación de "entornos de salud" MHS y para sistemas de asistencia sanitaria innovadores a nivel nacional. El Proyecto Epidaurus representa una colaboración destacada entre la medicina civil y los militares en tiempos de guerra.

Putting patients first: patient-centered care: more than the sum of its parts.

This is the seventh and last in a series of articles from Planetree, an international non profit organization founded in 1978 that's "committed to improving medical care from the patient's perspective." For more information, go to www.planetree.org. To register for a free Webinar based on this series that starts on September 21, go to http://bit.ly/aezmEu.

Putting patients first: Partnering with patients' families.

This is the sixth in a series of articles from Planetree, an international nonprofit organization founded in 1978 that's "committed to improving medical care from the patient's perspective." For more information, go to www.planetree.org.

Patient-centred care: more than the sum of its parts--Planetree's patient-centred hospital designation programme.

When a nurse at the Celilo Cancer Center at the Mid-Columbia Medical Center in The Dalles, Oregon, found out that his patient was scheduled to receive chemotherapy on her wedding anniversary, he asked the woman and her husband what song they'd first danced to on their wedding day. It was "Save the Last Dance For Me," and the next day, when the couple rose from their chairs after the patient's six-hour infusion, the song began playing. Right there in the infusion area, with their arms around each other, they danced. This story illustrates the kind of care that has become the norm at the 10 hospitals in North America recognized since 2007 as patient-centred hospitals by Planetree's Patient-Centred Hospital Designation Program. At these hospitals "patient-centred care" is more than a buzzword. Rather, it's reflected in their mission statements, strategic plans, models of nursing care, and day-to-day operations. While many organizations, including the Institute of Medicine, the Institute for Healthcare Improvement, and Planetree, have endeavored to define patient-centred care, no definition conveys its essence as well as the patients at these hospitals can. "This place has a special character," one patient said in a focus group. Others have said, "You can tell the nurses here care about you as a person," "They are a special breed of people here," and "I don't think it's just a job for them; they're here for a reason." Over the past year, this series, Putting Patients First, has explored several aspects of the patient-centered approach--encouraging patients to review their medical records, lifting restrictions on family involvement in care, and lowering noise levels in hospitals, among others. We believe they show that, ultimately, patient-centered care is more than the sum of its parts.

Open medical records.

This is the third in a series of articles from Planetree, an international nonprofit organization founded in 1978 that's "committed to improving medical care from the patient's perspective." For more information, go to www.planetree.org.

Building the business case for patient-centered care.

Hospitals that provide patient-centered care reap a number of financial benefits, including: Reduced length of stay. Lower cost per case. Decreased adverse events. Higher employee retention rates. Reduced operating costs. Decreased malpractice claims. Increased market share.