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Engaging Patients to Improve the Quality and Effectiveness of Care


A number of quality improvement strategies in the health reform law, such as patient-centered medical homes, depend on actively engaged and empowered patients. To become engaged, patients must not only understand their conditions, but also become more involved in their own care. Navigating a complex and often uncoordinated health care system can be a formidable task, especially for those patients with multiple conditions.

The latest issue of Quality Matters describes several programs that use innovative assessment and self-management tools to help patients gain the information and knowledge necessary for effective self-care.

One is a Web-based tool ( that lets patients assess their own health and share this information with their health care providers. Another, the Patient Activation Measure, is a survey instrument used to assess patients' confidence in their ability to manage their own conditions. Both can help providers identify ways to partner with their patients and to provide the resources, motivation, and support they need to manage their care.

Some providers have begun to use shared decision-making tools, including DVDs and customized educational materials, to help patients explore their options for treatment.

The case study in this issue looks at how Medica Health Plans, a Minnesota-based insurer, is using health coaches to help its members strengthen their self-management skills, boost their confidence, and achieve their health goals. The program has reduced health care expenditures, hospitalizations, and emergency department use while increasing enrollees' quality-of-life and satisfaction ratings. Key to the success of health coaching—and what distinguishes it from typical disease management programs that encourage patients to follow treatment guidelines—is that it is patient-directed. Patients set their own goals, such as losing weight, while coaches provide support to help them measure and achieve success.

Making these tools available to providers and patients nationwide will require considerable staffing resources, potentially different reimbursement policies, and modifications of the tools to meet the needs of diverse populations. But such investment may yield costs savings and improved health outcomes.

Publication Details



M. Hostetter and S. Klein, Engaging Patients to Improve the Quality and Effectiveness of Care, The Commonwealth Fund, December 2010.