More patient involvement in decision making could help reduce health costs

There is growing evidence that the more engaged patients are in their health care decision, the better the outcomes.    Much research — including several studies published in the current issue of Health Affairs — found that patients with the lowest involvement in their care  had average costs 8% higher than those with the highest range on an activation (involvement) scale.

But doctors still aren’t using that information to their advantage and better engaging patients, panelists at a recent  Institute of Medicine (IOM) workshop on patient engagement said.   More resources need to be invested in getting physicians and healthcare systems to increase patients’ involvement in decisions about their care, advocates said here.

“We just haven’t spent enough time helping clinicians develop these skills,” Eric Holmboe, MD, chief medical officer at the American Board of Internal Medicine, said.

Despite the availability of continuing medical education (CME) courses for physician  in the topic of patient engagement, few are attending them.

Monday’s IOM workshop follows a report last month that found Americans live sicker lives and die younger than those in other countries despite the impression that the US has the greatest health care in the world. Many believe there is the need to change the physician culture and convince doctors to accept a greater dialogue with patients, and a representative of GroupHealth, a health plan in Seattle, described his plan’s successful patient engagement initiative.

The provider organization, which serves 600,000 Washington residents, undertook a multi-pronged program that included offering patient education on joint-replacement surgeries and alternatives. They offered a half-day CME opportunity on how to discuss options with patients and emphasized to physicians that this was a patient safety issue.

GroupHealth experienced a 26% drop in the number of hip replacements and a 12% to 21% cost reduction after 3-plus years in the program, David Arterburn, MD, MPH, of GroupHealth, said.

Jonathan Welch, MD, Harvard Medical School, said providers need to find better ways to listen to patients and their families. He said the healthcare sector, unlike other service industries, doesn’t listen well to feedback from its consumers.

Excerpted from MedPage Today, Feb. 25, 2013 by David Pittman