Total Engagement and Activation Measure (TEAM): Developing a measure of the capacity for patients to engage in their health care

随着越来越重视让患者成为其健康和保健的合作伙伴并往往是其推动者， 患者参与被视为实现改善体验的三重目标的必要组成部分 医疗保健、改善人口健康和降低人均保健费用。这项研究的目标是 制定以患者为中心的参与度衡量标准，以提高我们对患者参与度的理解 患者和临床医生的观点，这允许识别个体差异在 患者参与度的维度。随着医疗政策越来越多地激励以患者为中心和 对于患者参与的护理，迫切需要制定和验证这一措施。 我们提出了一个多阶段的研究，旨在开发和实施心理测量学的有效工具。 这衡量了患者参与医疗保健的能力，总参与度和激活度 测量(团队)。这一主要研究目标的实现还涉及三个具体目标：1)发展 患者参与度的概念模型，反映了患者和临床医生对 参与，并考虑到参与发生的背景；2)利用国家卫生研究院 PROMIS®方法对这一新的测量方法进行仪器开发和验证(IDV) 患者参与的能力；以及3)这一新开发的措施在“现实世界”中的管理 设置一个大型学术医疗中心，以检查患者敬业度各组成部分的可变性 在住院患者的不同亚群中。 开发全面的团队测量工具将使未来能够探索一系列 持续和重要的研究问题，如政策、提供商薪酬和新的 技术支持促进患者参与的那种护理。更好地理解 患者参与度的概念及其测量将阐明支持患者的最有效方式 成为他们护理的合作伙伴，以改善和维持他们的健康，并随后允许 确定可在今后的研究和倡议中加以利用的可采取行动的干预点 增加患者参与度。

With increasing emphasis on engaging patients as partners in and often drivers of their health and health care, patient engagement is seen as a necessary component in achieving the triple aim of improved experience of care, improved health of populations, and lower per capita health care costs. The goal of this research is to develop a patient-focused engagement measure that improves our understanding of patient engagement from the perspective of patients and clinicians, and that allows for identification of individual differences in the dimensions of patient engagement. As healthcare policies increasingly incentivize patient-centered and patient-engaged care, there is a critical need for the development and validation of such a measure. We propose a multi-phase study aimed at developing and implementing a psychometrically valid instrument that measures the capacity of patients to engage in their health care, the Total Engagement and Activation Measure (TEAM). Accomplishment of this major study aim will also involve three specific aims: 1) development of a conceptual model of patient engagement that reflects shared perspectives of patients and clinicians about engagement and takes into account the context in which engagement happens; 2) utilization of the NIH PROMIS® methodology to conduct Instrument Development and Validation (IDV) for this new measure of the capacity for patient engagement; and 3) administration of this newly developed measure in the `real world' setting of a large academic medical center to examine variability in the components of patient engagement across different subgroups of hospitalized patients. Development of the comprehensive TEAM measurement tool will enable future exploration of a series of ongoing and significant research questions such as how shifts in policy, provider remuneration, and new technologies support the kind of care that facilitates patient engagement. Achieving a greater understanding of the concept of patient engagement and its measurement will clarify the most effective ways to support patients in becoming partners in their care in order to improve and maintain their health, and subsequently allow for the identification of actionable points of intervention that can be leveraged in future studies and initiatives aimed at increasing patient engagement.