Impact of Patient Activation and Engagement on Patient-Centered Outcomes of Care in ACOs
Impact of Patient Activation and Engagement on Patient-Centered Outcomes of Care in ACOs
The investigators will study the delivery of care to patients with diabetes and
 cardiovascular diseases from 16 practices in health care organizations who receive incentives
 for improving the quality of patient care. Half of those will be far along in engaging
 patients in their care and half will not. The investigators will see whether patients with
 diabetes or cardiovascular diseases who receive care from practices that more fully involve
 their patients have better clinical outcomes and satisfaction with their care than those who
 do not. The investigators expect that these findings will help practices and patients to
 achieve better outcomes of care.
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