Impact of Patient Activation and Engagement on Patient-Centered Outcomes of Care in ACOs

BACKGROUND Engaged patients have been referred to as "…the blockbuster drugs of the 21st
century". Under the Affordable Care Act (ACA), Accountable Care Organizations (ACOs) are
required to engage patients. The specific question we will address is: Do patients receiving
care from ACO practices with highly developed patient activation and engagement (PA&E)
activities achieve better patient reported health outcomes, report better experiences of
care, and have better selected clinical measures (blood pressure, hemoglobin levels, and
LDL-C) compared to patients receiving care from ACO practices with less developed PA&E
initiatives? We plan to capitalize on the natural occurring variation in degree of
implementing PA&E activities.

OBJECTIVES

1) To collect information on the PA&E activities in 16 practices of two ACOs at baseline and
over three years - including initiatives focused on disease prevention and health promotion,
care team-patient communication, shared decision-making, self-management support, advanced
serious illness care, and patient involvement in the care redesign experience; 2) to assess
the differences on patient-reported outcomes of care, patient experiences, and selected
clinical measures between patients exposed to highly developed PA&E initiatives versus those
receiving care from practices with minimal PA&E activities; and 3) examine practice-level
variation in PA&E implementation processes including culture, leadership, teamwork, and
relational coordination.

METHODS We will take advantage of the naturally occurring variation in the implementation of
PA&E activities in 16 practices of two ACOs treating patients with diabetes and
cardiovascular disease (CVD). A random sample of chronically-ill patients from each of the
two ACOs will be sampled and will complete a patient-reported outcome instrument that
includes select Patient-Reported Outcomes (PROMIS) measures and patient experience measures
in early and late stages of the project. They will also complete the patient activation
measure (PAM). We will examine changes over time in the outcome variables noted above. We
will also survey ACO/ practice stakeholders regarding organizational culture, leadership,
team effectiveness, and relational coordination using previously validated instruments
supplemented by site visits. Multilevel analyses examine PA&E effects and practice-level
heterogeneity within ACOs, controlling for patient characteristics.

PATIENT OUTCOMES The proposed project's explicit focus on examining the PA&E activities of
ACO practices with highly developed PA&E activities in comparison with those with very little
and linking these to the outcomes measures noted above should be of great interest to
patients, the Patient-Centered Outcomes Research Institute (PCORI), and the health care
policy and practitioner community. The findings should help to guide PCORI's future research
agenda in this area while providing all involved with knowledge to advance patient-centered
care.

Inclusion Criteria:

- adult, 18-82

- diagnosis of diabetes or cardiovascular disease

- receives primary care at one of 16 selected clinical sites from two Accountable Care
Organizations

Exclusion Criteria:

- Incomplete mailing address available from Electronic Medical Record

- Patient language other than English or Spanish