Impact of Patient Activation and Engagement on Patient-Centered Outcomes of Care in ACOs
Condition: Diabetes; Cardiovascular Disease
MeSH terms: Cardiovascular Diseases
Study type: Observational

Summary: 
      The investigators will study the delivery of care to patients with diabetes and
      cardiovascular diseases from 16 practices in health care organizations who receive incentives
      for improving the quality of patient care. Half of those will be far along in engaging
      patients in their care and half will not. The investigators will see whether patients with
      diabetes or cardiovascular diseases who receive care from practices that more fully involve
      their patients have better clinical outcomes and satisfaction with their care than those who
      do not. The investigators expect that these findings will help practices and patients to
      achieve better outcomes of care.
    

Detailed description: 
      BACKGROUND Engaged patients have been referred to as "…the blockbuster drugs of the 21st
      century". Under the Affordable Care Act (ACA), Accountable Care Organizations (ACOs) are
      required to engage patients. The specific question we will address is: Do patients receiving
      care from ACO practices with highly developed patient activation and engagement (PA&E)
      activities achieve better patient reported health outcomes, report better experiences of
      care, and have better selected clinical measures (blood pressure, hemoglobin levels, and
      LDL-C) compared to patients receiving care from ACO practices with less developed PA&E
      initiatives? We plan to capitalize on the natural occurring variation in degree of
      implementing PA&E activities.

      OBJECTIVES

      1) To collect information on the PA&E activities in 16 practices of two ACOs at baseline and
      over three years - including initiatives focused on disease prevention and health promotion,
      care team-patient communication, shared decision-making, self-management support, advanced
      serious illness care, and patient involvement in the care redesign experience; 2) to assess
      the differences on patient-reported outcomes of care, patient experiences, and selected
      clinical measures between patients exposed to highly developed PA&E initiatives versus those
      receiving care from practices with minimal PA&E activities; and 3) examine practice-level
      variation in PA&E implementation processes including culture, leadership, teamwork, and
      relational coordination.

      METHODS We will take advantage of the naturally occurring variation in the implementation of
      PA&E activities in 16 practices of two ACOs treating patients with diabetes and
      cardiovascular disease (CVD). A random sample of chronically-ill patients from each of the
      two ACOs will be sampled and will complete a patient-reported outcome instrument that
      includes select Patient-Reported Outcomes (PROMIS) measures and patient experience measures
      in early and late stages of the project. They will also complete the patient activation
      measure (PAM). We will examine changes over time in the outcome variables noted above. We
      will also survey ACO/ practice stakeholders regarding organizational culture, leadership,
      team effectiveness, and relational coordination using previously validated instruments
      supplemented by site visits. Multilevel analyses examine PA&E effects and practice-level
      heterogeneity within ACOs, controlling for patient characteristics.

      PATIENT OUTCOMES The proposed project's explicit focus on examining the PA&E activities of
      ACO practices with highly developed PA&E activities in comparison with those with very little
      and linking these to the outcomes measures noted above should be of great interest to
      patients, the Patient-Centered Outcomes Research Institute (PCORI), and the health care
      policy and practitioner community. The findings should help to guide PCORI's future research
      agenda in this area while providing all involved with knowledge to advance patient-centered
      care.
    

Intervention name(s): Observational: Patient Activation and Engagement (PAE)
Intervention type(s): Other
Intervention description(s): Observational: Patients receive care from clinics with either low or high levels of patient activation and engagement activities.
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        4368 patients with diabetes or cardiovascular disease receiving care from selected clinics
        at two Accountable Care Organizations in Los Angeles, CA and Chicago, IL.
      
Keywords: Patient activation and engagement; Patient reported outcomes; Accountable Care Organizations; Chronic illness; Vulnerable population; Comparison of approaches