Key Element Missing in Healthcare Decisions: Patients

February 4, 2013

We all are patients at some point and experience the challenges of making important healthcare decisions, often with less information then we need to make informed decisions. Having a “patient-centered” health system is a commonly cited goal of health reforms. Though there is general recognition that engaging patients in the critical decisions affecting their health are central to improving health and healthcare system performance, there are still significant gaps between what patients want and what they actually receive.

An IOM discussion paper, “Communicating with Patients on Health Care Evidence,” released last year documented these gaps. Across several categories patients strongly agreed that our healthcare system isn’t yet patient-centered. Gaps between what patients want and what they get included having providers who listen, explain risks, discuss the option of no treatment or test, take the time to understand the patient’s goals and concerns, and coordinate care with other providers. Among people with one or more chronic conditions, 97 percent agreed that their care ought to be well coordinated between the various healthcare professionals working on their case, but slightly more than half felt that coordination was actually taking place. Given the health benefits and cost savings generated from coordinating care for the chronically ill, this gap represents an enormous missed opportunity.

Research on patient engagement demonstrates the largely untapped potential for improvement. For example, poor medication adherence rates cost the healthcare system $300 billion a year, but shared decision making when it comes to medication management improves both adherence and health outcomes for patients with asthma, diabetes, and other chronic conditions. For patients deciding to undergo elective surgery for hip or knee replacements, receiving a patient decision aid reduced the rate of both surgeries. Both public and private insurers have successfully implemented shared decision making programs resulting in lower cost and utilization, improved adherence to treatment, and enhanced quality and patient satisfaction. In a telephonic care support and shared decision making study, reduced hospital expenditures, improved medication adherence, and fewer patients opting for elective surgeries generated a greater than 3 to 1 return on investment.

This month’s Health Affairs is dedicated to patient engagement including studies of promising models improving outcomes and lowering costs through informed decision-making and patient empowerment. Given the foundational role patient engagement plays in achieving the health improvements we both need and seek, this edition is a must read for policymakers and health reformers.