Concept Mapping as a Method to Engage Patients in Clinical Quality Improvement

Abstract

Patient engagement has become a primary care research and practice priority. Little guidance exists, however, on how best to engage patients in primary care practice improvement, or how to measure the impact of their engagement. We present an overview of group concept mapping as a method for engaging patients in primary care practice improvement. We detail the group concept mapping process as a tool for use in primary care practice improvement, research, and evaluation, and we present resources to enable researchers and practice leaders to use this tool in practice improvement. To illustrate the method, we present a practice-based quality improvement project conducted with patients and staff at a large urban academic primary care practice. 2016;14:370-376. doi: 10.1370/afm.1929. Ann Fam Med INTRODUCTIONP atient engagement has been described as a "coming revolution" 1 and as a "blockbuster prescription" 2 for improving health care. It is prioritized in research funding at the Patient-Centered Outcomes Research Institute (PCORI) and the Agency for Healthcare Research and Quality (AHRQ), and it is mandated by the National Committee for Quality Assurance for patient-centered medical home (PCMH) accreditation. Patient engagement may occur across the dimensions of direct care, organizational design and governance, and policy making according to a framework proposed by Carman et al. 3 This framework posits that a continuum of engagement exists within each of these dimensions: at the highest level of the organizational design dimension, patients co-lead initiatives, including quality improvement initiatives. 3 Research supports positive outcomes associated with patient engagement in quality improvement: a systematic review by Crawford et al 4 showed that patient involvement in quality improvement efforts led to improved patient information resources and access to care. Furthermore, a recent AHRQ guide for patient and family advisory programs noted that patient involvement in improvement efforts can lead to better quality, safety, and patient and staff satisfaction. 5 Increasingly, primary care practices, including PCMHs, attempt to engage patients across a continuum that includes research and practice improvement. Early evidence suggests that practices that have involved patients in medical home transformation efforts view the engagement positively. 6,7 Attempts to engage patients in quality improvement efforts remain uncommon, however. A recent survey of 123 PCMHs found that fewer than one-third engaged patients in these efforts, although most of them reported soliciting patient input in other areas. 6 Another survey of 249 small PCMHs found that only 15% included patients on quality improvement teams.8 One barrier to directly engaging patients may be the lack of guidance on a clear method of doing so.Medical practices typically solicit patient input in practice improvement through suggestion boxes and surveys, and increasingly, with patient advisory boards. 6,5 Interviews and focus groups are more common in ...

Determining requirements for patient-centred care: a participatory concept mapping study

“…While its origins are in evaluation and planning, it has been used to address health care issues [ 44 , 45 ]. Group concept mapping is well suited to garnering the views of a broad group of people, has the potential to capture and represent stakeholder groups, is uniquely suited to community-engaged research [ 36 , 46 ], and is identified as an effective methodology for engaging patients in clinical improvement activities [ 47 ].…”

“…Cluster analysis is a statistical technique used to develop a higher order understanding of the relationship between statements represented in the point map. The process involves drawing a set of boundaries on the point map to create different numbers of clusters [ 47 ]. Bridging values for each statement identified which statements are anchoring -sorted primarily with others close by, and which are bridging - sorted with others across a larger area of the map.…”

Patient and caregiver experience in the transition from hospital to home — brainstorming results from group concept mapping: a patient-oriented study

“…It has also been used to engage patients in clinical quality improvement. 21 We report on the first phase of concept mappingbrainstorming -which engages participants in generating ideas relevant to the research question. Research has shown that brainstorming in group concept mapping is highly effective and efficient at identifying outcomes important to patients compared to traditional qualitative methods.…”

‘Spending the day with your Family Health Team’: rapid ethnography of a patient-centred quality improvement event

“…Primary care practices have started to explore different methods of engaging with patients to advance quality improvement. 6 The authors' primary care Family Health Team (FHT) organisation chose to leverage methods of citizen engagement to develop and host a 1-day patient engagement event designed to gather feedback on core services. 7 To the authors' knowledge, there has been no empirical research to understand the impact of such an approach; therefore, the authors undertook a rapid ethnographic evaluation of the event to understand its impact and what context and mechanisms might relate to potential success.…”