The immaturity of patient engagement in value-based healthcare—A systematic review

Abstract

IntroductionIn recent years, Value-Based Healthcare (VBHC) has been gaining traction, particularly in hospitals. A core VBHC element is patient value, i.e., what matters most to the patient and at what cost can this be delivered. This interpretation of value implies patient engagement in patient–doctor communication. Although patient engagement in direct care in the VBHC setting is well described, patient engagement at the organizational level of improving care has hardly been studied. This systematic review maps current knowledge regarding the intensity and impact of patient engagement in VBHC initiatives. We focus on the organizational level of a continuous patient engagement model.MethodsWe performed a systematic review following PRISMA guidelines using five electronic databases. The search strategy yielded 1,546 records, of which 21 studies were eligible for inclusion. Search terms were VBHC and patient engagement, or similar keywords, and we included only empirical studies in hospitals or transmural settings at the organizational level.ResultsWe found that consultation, using either questionnaires or interviews by researchers, is the most common method to involve patients in VBHC. Higher levels of patient engagement, such as advisory roles, co-design, or collaborative teams are rare. We found no examples of the highest level of patient engagement such as patients co-leading care improvement committees.ConclusionThis study included 21 articles, the majority of which were observational, resulting in a limited quality of evidence. Our review shows that patient engagement at the organizational level in VBHC initiatives still relies on low engagement tools such as questionnaires and interviews. Higher-level engagement tools such as advisory roles and collaborative teams are rarely used. Higher-level engagement offers opportunities to improve healthcare and care pathways through co-design with the people being served. We urge VBHC initiatives to embrace all levels of patient engagement to ensure that patient values find their way to the heart of these initiatives.

“It’s My Life and It’s Now or Never”—Transplant Recipients Empowered From a Service-Dominant Logic Perspective

“…Whereas VBHC is aiming to create value for the patient, we argue that value is created with and by the patient. On this basis, we would urge the intensification of patient involvement in designing healthcare services on the grounds that patients are the cocreators of value in healthcare and well-being [50][51][52][53][54].…”

Evaluating patient participation in value‐based healthcare: Current state and lessons learned

“…Although the impact of collective patient participation in VBHC has been stipulated, 4,11,12 thus far, there is a paucity of literature on practical implementation and evaluation of collective patient participation within VBHC. 15 Therefore, the process and impact of collective patient participation need to be evaluated to identify best practices for patient participation in VBHC. In this study, we aimed to evaluate the experiences with collective patient participation within multidisciplinary VI teams using a mixed-methods approach.…”

“…11,12 The focus of literature regarding patient participation in VBHC has mainly been at the individual level, that is, by using outcome data for shared decision-making. 13,14 However, there is a lack of evidence and examples of best practices for collective patient participation, 15 and multiple barriers to participation have been mentioned in literature. 16 For example, a frequently mentioned barrier is that generally higher educated patients are involved at the collective level, resulting in underrepresentation of a large group of (lower educated) patients at this level.…”