Engaging High-Need Patients in Intensive Outpatient Programs: A Qualitative Synthesis of Engagement Strategies

Abstract

Promising clinical, interpersonal, and population-based approaches to engaging high-need patients frequently deviate from standard practice and require creative and proactive staff with adequate time, resources, and flexibility to address patients' needs on patients' terms.

Defining case management success: a qualitative study of case manager perspectives from a large-scale health and social needs support program

“…26 In another study interviewing clinicians and leaders across 12 intensive outpatient programmes, three key facilitators of patient engagement emerged: (1) financial assistance and other resources to help meet basic needs, (2) working as a multi-disciplinary care team and (3) adequate time and resources to develop close relationships focused on patient goals. 27 Our results concur on the importance of a multi-disciplinary approach, establishing trusting relationships, and pursuing patient-centred goals. Our results diverge on the role of resources to meet basic needs.…”

“…For example, interdisciplinary staff in a qualitative study of an ambulatory intensive care centre also identified warm relationships between patients and staff as a marker of success 26. In another study interviewing clinicians and leaders across 12 intensive outpatient programmes, three key facilitators of patient engagement emerged: (1) financial assistance and other resources to help meet basic needs, (2) working as a multi-disciplinary care team and (3) adequate time and resources to develop close relationships focused on patient goals 27. Our results concur on the importance of a multi-disciplinary approach, establishing trusting relationships, and pursuing patient-centred goals.…”

“…Existing research finds that patients’ trust in their primary care physician is associated with greater self-reported medication adherence31 along with health behaviours such as exercise and smoking cessation 32. Similar quantitative results have not yet been illuminated in social needs case management contexts, yet the prominence of trusting relationships in this study as well as other sources26 27 33 34 suggests that measures of trust should be used to complement currently emphasised outcomes such as inpatient and outpatient utilisation. Future research and programme evaluation will need to develop new trust measurement or modify existing trust measures for the social needs case management context 31 35…”

“It’s Like Riding Out the Chaos”: Caring for Socially Complex Patients in an Ambulatory Intensive Care Unit (A-ICU)

“…Our final finding suggests that A-ICU team members view their proximal goal as increased engagement rather than reducing utilization. As a recent study highlighted, 22 success of intensive outpatient programs may be predicated on the ability to improve patient participation in their health care. Their findings of how intensive primary care programs improve engagement parallel our findings: the importance of multidisciplinary team composition, having requisite time and resources, and flexible approaches to patient goals.…”

What Is the Return on Investment of Caring for Complex High-need, High-cost Patients?

“…[22][23][24] Perhaps because the VHA is an integrated system, providers did not find poor coordination to be the most important factor. Instead, non-adherence, lack of engagement (defined here as a patient's participation in self-care and other health-related activities, motivation and ability to address health issues, and shared decision-making [25][26][27] ) and behavioral health issues dominated.…”