Types of Engagement Strategies to Engage High-Risk Patients in VA

Alicia A Bergman; Susan E Stockdale; Donna M Zulman; Marian L Katz; Steven M Asch; Evelyn T Chang

doi:10.1007/s11606-023-08336-8

Types of Engagement Strategies to Engage High-Risk Patients in VA

J Gen Intern Med. 2023 Nov;38(15):3288-3294. doi: 10.1007/s11606-023-08336-8. Epub 2023 Aug 24.

Authors

Alicia A Bergman¹, Susan E Stockdale^{2

3}, Donna M Zulman^{4

5}, Marian L Katz², Steven M Asch^{4

5}, Evelyn T Chang^{2

6

7}

Affiliations

¹ VA Health Services Research and Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. Alicia.Bergman@va.gov.
² VA Health Services Research and Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
³ Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA.
⁴ VA HSR&D Center for Innovation to Implementation, Menlo Park, CA, USA.
⁵ Division of Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, CA, USA.
⁶ Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
⁷ Division of General Internal Medicine, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.

PMID: 37620722
PMCID: PMC10681963 (available on 2024-11-01)
DOI: 10.1007/s11606-023-08336-8

Abstract

Background: Many healthcare systems seek to improve care for complex high-risk patients, but engaging such patients to actively participate in their healthcare can be challenging.

Objective: To identify and describe types of patient engagement strategies reported as successfully deployed by providers/teams and experienced by patients in a Veterans Health Administration (VA) intensive primary care (IPC) pilot program.

Methods: We conducted semi-structured qualitative telephone interviews with 29 VA IPC staff (e.g., physicians, nurses, psychologists) and 51 patients who had at least four IPC team encounters. Interviews were recorded, transcribed, and analyzed thematically using a combination a priori/inductive approach.

Results: The engagement strategies successfully deployed by the IPC providers/teams could be considered either more "facilitative," i.e., facilitated by and dependent on staff actions, or more "self-sustaining," i.e., taught to patients, thus cultivating their ongoing patient self-care. Facilitative strategies revolved around enhancing patient access and coordination of care, trust-building, and addressing social determinants of health. Self-sustaining strategies were oriented around patient empowerment and education, caregiver and/or community support, and boundaries and responsibilities. When patients described their experiences with the "facilitative" strategies, many discussed positive proximal outcomes (e.g., increased access to healthcare providers). Self-sustaining strategies led to positive (self-reported) longer-term clinical outcomes, such as behavior change.

Conclusion: We identified two categories of strategies for successfully engaging complex, high-risk patients: facilitative and self-sustaining. Intensive primary care program leaders may consider thoughtfully building "self-sustaining" engagement strategies into program development. Future research can confirm their effectiveness in improving health outcomes.

MeSH terms

Health Personnel
Humans
Patient Participation
Patients
Physicians*

Grants and funding

XVA 65-54/Office of Patient Care Services, Department of Veterans Affairs