An international survey of adults with complex health care needs found wide variations in the degree to which patients are engaged in their own care, from self-managing a health condition to actively participating in treatment decisions. Across countries, engaged patients reported fewer medical errors, higher care ratings, and more positive views of the health system as a whole.
When patients have an active role in their own health care, the quality of their care, and of their care experience improves, studies show. Efforts to increase patients’ engagement in their care—for example, through shared decision-making and self-management of a chronic condition—have proliferated internationally as nations strive for high-value, high-performance health systems. This study, authored by Commonwealth Fund researchers, examines results from a 2011 Fund survey in 11 countries focusing on patients with complex health care needs.
The survey findings reveal that there is room for improvement in each country when it comes to patient engagement. Switzerland and the U.K., however, stand out for their consistently high performance in this critical area of health care. Despite stark differences in their insurance and care delivery, the two countries have the highest share of patients with "medical homes"—primary care providers that ensure timely access to care, know their patients’ medical histories, arrange for specialist services, and coordinate overall treatment. This strong correlation suggests that spreading the medical home model may also improve engagement. In the U.S., the Affordable Care Act includes strong incentives and support for patient-centered medical homes, as well as for accountable care organizations designed to motivate providers to deliver high-quality, efficient care.
Data for the study were obtained from the 2011 Commonwealth Fund International Health Policy Survey, which included more than 18,000 adults age 18 or older who were in fair or poor health, had recently been hospitalized or had major surgery, or had a serious illness or injury in the past year in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. Interviews were conducted by telephone between March and June 2011.
A cross-national study finds that patients who are engaged in their own health care receive higher-quality care, experience fewer medical errors, and have more positive views of the health system.