Promoting Patient and Family Partnerships in Ambulatory Care Improvement: A Narrative Review and Focus Group Findings

Abstract

IntroductionAmbulatory practices that actively partner with patients and families in quality improvement (QI) report benefits such as better patient/family interactions with physicians and staff, and patient empowerment. However, creating effective patient/family partnerships for ambulatory care improvement is not yet routine. The objective of this paper is to provide practices with concrete evidence about meaningfully involving patients and families in QI activities.MethodsReview of literature published from 2000–2015 and a focus group conducted in 2014 with practice advisors.ResultsThirty articles discussed 26 studies or examples of patient/family partnerships in ambulatory care QI. Patient and family partnership mechanisms included QI committees and advisory councils. Facilitators included process transparency, mechanisms for acting on patient/family input, and compensation. Challenges for practices included uncertainty about how best to involve patients and families in QI. Several studies found that patient/family partnership was a catalyst for improvement and reported that partnerships resulted in process improvements. Focus group results were concordant.ConclusionThis paper describes emergent mechanisms and processes that ambulatory care practices use to partner with patients and families in QI including outcomes, facilitators, and challenges.FundingGordon and Betty Moore Foundation.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-016-0364-z) contains supplementary material, which is available to authorized users.

Increasing patient engagement in healthcare service design: a qualitative evaluation of a co-design programme in New Zealand

“…Using more than one option allows experience capture methods to be tailored to individuals and patient groups, enabling patients to communicate in ways they are comfortable with. The current and previous studies 22,25 have identified that securing a diverse group of patient participants in codesign is challenging. Involvement across the patient spectrum is important to ensure a representative spread of patients.…”

Who represents me? A patient‐derived model of patient engagement via patient and family advisory councils (PFACs)

“…A delegate model requires PFACs to connect with their constituency, at least enough to learn their preferences . In prior studies, PFAC members have themselves expressed the desire to learn more about the preferences of other patients …”

“…While case studies suggest how PFACs could improve the safety and quality of patient care, systematic and structured reviews have repeatedly demonstrated a lack of rigorous evaluation and evidence of such impact . Much work remains to ensure PFACs can further patient‐ and family‐centred change in diverse health‐care settings …”

Patient, Family, and Community Advisory Councils in Health Care and Research: a Systematic Review

“…19,20 A 2006 systematic review on mechanisms of patient engagement found little evidence from randomized controlled trials on the impact of PFACs and similar organizations on health care decisions at the population level other than in the development of patient information material, which is more relevant and understandable when PFACs were involved. 11 Reviews of the effects of PFACs on ambulatory adult clinics, 21 engagement in research only, [22][23][24] or the impact of such programs on the people involved 25 have also shown that transparency of process, compensation of patients, stakeholder engagement, and contextual factors impact patient engagement, but that gaps in research on impact on health systems persist.…”

“…We used the framework of Carman, et al, which defines three levels where patient engagement is needed: direct care, organizational design, and policy-making, 10 and due to the growing recognition of the value of community-engaged research, we added a fourth level, engagement in research. [26][27][28][29] As earlier systematic reviews have not engaged patients and/or PFAC members in their analysis teams, [21][22][23][24][25] a lack of understanding of the feasibility or impact of engaging the public in systematic reviews persists. 30 Given this gap, and because multiple stakeholders are often needed for an ecological perspective that attends to a complex problem in health care, 31 a secondary aim of this review was to test the feasibility of having a PFAC member participate in the conduct of a systematic review.…”