Development of a conceptual model of the capacity for patients to engage in their health care: a group concept mapping study.
Development of a conceptual model of the capacity for patients to engage in their health care: a group concept mapping study.
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DOI：
10.1186/s12913-023-09785-x
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发表时间：
2023-08-10
影响因子：
2.8
通讯作者：
Sieck, Cynthia J.
中科院分区：
文献类型：
--
作者：
Di Tosto, Gennaro;Hefner, Jennifer L.;Walker, Daniel M.;Gregory, Megan E.;McAlearney, Ann Scheck;Sieck, Cynthia J.
患者参与被视为实现改善人口健康、改善护理体验和降低人均医疗保健成本三重目标的必要组成部分。尽管旨在帮助患者参与健康决策的工具和以患者为中心的举措数量大幅增加，但从患者的角度对参与的理解仍然有限，并且缺乏旨在捕捉这一概念的多方面性质的措施。患者参与的概念图的开发遵循五步修改后的团体概念图（GCM）方法的准备，生成，结构化，分析和解释。我们在每一步都聘请了一个项目咨询委员会，沿着从临床医生和患者那里收集了三轮调查，用于元素生成（272名临床医生，61名患者）、声明排序（30名临床医生，15名患者）以及声明的排名和评级（159名临床医生，67名患者）。三个独立样本的调查，而不是“专家”的焦点小组，是一个有意的决定，以获得关于患者参与的概念的广泛观点。我们在groupwisdom概念图软件中进行了结构和分析步骤。最终的概念图包括47个元素，分为5个集群：与供应商的关系，病人的态度和行为，访问，内部资源和外部资源。患者和临床医生对每个聚类中的元素进行评级的方式相当一致。患者参与的构成要素相对于他们的可寻址性的重要性的分析突出了可操作的项目在域中的关系与供应商，旨在建立信任，使患者提出问题。与此同时，分析还发现了传统上被认为是参与障碍的因素，如个人访问互联网和患者的数字素养水平，这些因素很难被医疗系统解决，但对患者来说也相对不那么重要。通过我们的GCM方法，结合患者和临床医生的观点，我们确定了可用于评估医疗保健系统患者参与工作的项目。因此，我们的研究为医疗保健系统干预以提高患者参与度的领域提供了具体的见解。在线版本包含补充材料，可通过10.1186/s12913-023-09785-x获得。
Patient engagement is seen as a necessary component in achieving the triple aim of improved population health, improved experience of care, and lower per capita health care costs. While there has been a substantial increase in the number of tools and patient-centered initiatives designed to help patients participate in health decisions, there remains a limited understanding of engagement from the perspective of patients and a lack of measures designed to capture the multi-faceted nature of the concept. Development of a concept map of patient engagement followed a five-step modified Group Concept Mapping (GCM) methodology of preparation, generation, structuring, analysis and interpretation. We engaged a Project Advisory Committee at each step, along with three rounds of survey collection from clinicians and patients for element generation (272 clinicians, 61 patients), statement sorting (30 clinicians, 15 patients), and ranking and rating of statements (159 clinicians, 67 patients). The survey of three separate samples, as opposed to focus groups of ‘experts,’ was an intentional decision to gain a broad perspective about the concept of patient engagement. We conducted the structure and analysis steps within the groupwisdom concept mapping software. The final concept map comprised 47 elements organized into 5 clusters: Relationship with Provider, Patient Attitudes and Behaviors, Access, Internal Resources and External Resources. There was considerable agreement in the way elements in each cluster were rated by patients and clinicians. An analysis of the importance of the constitutive elements of patient engagement relative to their addressability highlighted actionable items in the domain of Relationship with Provider, aimed at building trust and enabling patients to ask questions. At the same time, the analysis also identified elements traditionally considered barriers to engagement, like personal access to the internet and the patient’s level of digital literacy, as difficult to address by the healthcare system, but also relatively less important for patients. Through our GCM approach, incorporating perspectives of both patients and clinicians, we identified items that can be used to assess patient engagement efforts by healthcare systems. As a result, our study offers specific insight into areas that can be targeted for intervention by healthcare systems to improve patient engagement. The online version contains supplementary material available at 10.1186/s12913-023-09785-x.
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