How patients, ACOs, and researchers partner to achieve better health


February 23, 2017

Doctor interacts with young patientHow can the healthcare system get patients more involved in their own treatments in a way that improves their outcomes? Accountable Care Organizations (ACOs)—health care delivery systems that are held accountable to meet cost and quality criteria—are gaining in popularity as an answer to this question, but their methods and practices are in a state of constant revision and evaluation.

A study led by Center for Healthcare Organizational and Innovation Research (CHOIR) investigators at UC Berkeley School of Public Health and published February 3 in the Journal of General Internal Medicine, found that adult patients who were treated in a primary care practice site that promoted a patient-centered culture reported fewer depression symptoms and displayed better physical functioning. When patients became involved in their own treatment, which the researchers call “patient activation and engagement,” they gained the benefits of a patient-centered culture while also reporting better physical health, better social health and fewer depression symptoms.

“These findings add to a growing literature on the importance of engaging patients in their care to achieve better outcomes that matter to patients like how they function physically and socially. In addition, it breaks new ground by identifying specific features of primary care practices that appear to be associated with achieving such outcomes through increased patient engagement” says Stephen Shortell, principal investigator of the study and Blue Cross of California Distinguished Professor of Health Policy and Management.

The study, A Multilevel Analysis of Patient Engagement and Patient-Reported Outcomes in Primary Care Practices of Accountable Care Organizations, analyzed over 2,000 patients with diabetes and/or cardiovascular disease who received care at one of 16 practices within two large ACOs located in greater Chicago and Los Angeles. Through surveys and in person interviews of patients, clinicians, and staff, the researchers studied the leadership, culture, teamwork, communication, coordination, and patient engagement behaviors of each practice and examined how these were related to outcomes of care.

How engaged patients were in their care was directly associated with the quality of their care and better physical and social functioning. “This may be because more highly activated, engaged patients ask more questions to have their concerns addressed,” the authors suggest, “and, as a result, are more satisfied with their care experience and more motived to achieve desired outcomes.”

Currently, few ACOs or other health care delivery systems routinely collect patient activation or patient-reported measures of physical and social functioning to aid in managing diabetes and other chronic conditions. This will likely change as incentives to manage the cost of care and provide value to patients and purchasers are increased.

“Healthcare organizations will increasingly need to find ways to efficiently collect patient-reported data and strategies to use this information for monitoring treatment plans, engaging patients in their own care, and improving their health behaviors,” says Hector Rodriguez, study co-investigator and the Henry J. Kaiser Professor of Organized Delivery Systems.

The authors of this publication include Stephen M. Shortell, Bing Ying Poon, Patricia P. Ramsay, Hector P. Rodriguez, Susan L. Ivey, and Thomas Huber of the UC Berkeley School of Public Health; Jeremy Rich of HealthCare Partners Institute for Applied Research and Education, Los Angeles, CA; and Tom Summerfelt, Advocate Health, Chicago, Il.

This study was funded through a Patient-Centered Outcomes Research Institute Award and by an Agency for Healthcare Research and Quality Centers of Excellence Award.

By Jaron Zanerhaft