Unraveling the meaning of patient engagement: A concept analysis
Introduction
As contemporary healthcare evolves from a disease-centered to a patient-centered model [1], the concept of patient engagement assumes a pivotal role. The use of the term patient engagement has rapidly expanded in the health sciences. The concept has been referenced in literature published on patient-centered medical homes [2], comparative effectiveness research [3], use of technology for inpatient settings [4], ambulatory chronic care management [5], patient safety for prevention of adverse events [6] and controlling healthcare costs [7]. Definitions of patient engagement have varied over time and across contexts, however, rendering the essential nature of the concept elusive. Nevertheless, the US National Coordinator (ONC) of Health Information Technology has described patient engagement as one of the most underutilized resources in healthcare and a potential “blockbuster drug” [8], but has not referenced a definition of the concept.
The frequency of citations of the term “patient engagement” in the scientific literature has increased markedly since the introduction of the term in the 1990s, tripling between 2010 and 2013 in Web of Science. One reason for this increase is that the federal government now offers reimbursement for the use of health information technology to enhance patient engagement [9]. Conversations in social media and coverage by industry analysts reveal concerns about what patient engagement is and how to achieve it [10]. These concerns have arisen in part due to recent policy guidelines by the Centers for Medicare and Medicaid Services (CMS) that tie provider reimbursement to levels of patient engagement [11].
Accompanying this emphasis on patient engagement is emerging evidence of an association between patient engagement and quality in healthcare [12]. The meaning of the concept of patient engagement deserves close scrutiny to inform future practice, policy and research for improving quality of care. Outcomes research requires specific constructs and variables to measure the impact of patient engagement strategies, while efforts to improve the experiences of care may benefit from new insight into the definition of the concept of patient engagement. The varied and numerous references to patient engagement in the literature, combined with the emerging evidence of its potential to influence quality of care, constitute a relevant case for an in-depth analysis to construct a definition by determining the core attributes of the concept. Hence, the aim of this paper is to present a concept analysis of patient engagement to assemble that definition.
Section snippets
Methods
Roger’s Evolutionary Method [13] was used as the basis for this concept analysis. The method is comprised of six components described below where appropriate.
Identification of the concept of interest and associated expressions
The concept of patient engagement was identified due to its frequent, wide ranging references in recent literature.
No appropriate surrogate terms for patient engagement were identified as no other term proposes the same breadth of concept. We searched for definitions of related expressions such as patient-centered care, patient involvement, participation, activation and empowerment. Patient-centered care is defined by the Institute of Medicine as “Providing care that is respectful of and
Discussion
The large number of attributes assigned to each of the three domains (processes, behaviors, environment) suggests that the concept of patient engagement touches upon myriad dimensions of healthcare delivery. The concept influences relationships between actors in healthcare who execute processes, impact individual patient behaviors, and drive institutional practices. Many of the articles reviewed were published by interdisciplinary teams, with co-authors from medicine, nursing, public health,
Conflict of interest
The authors declare that they have no actual or potential conflict of interest including any financial, personal or other relationships with other people or organizations within three years of beginning the submitted work that could inappropriately influence, or be perceived to influence, their work.
Acknowledgements
Tracy Higgins was supported by the VA 9-11 GI Bill, the generous participation of the Columbia School of Nursing in the VA Yellow Ribbon Program, and the Jonas Veterans Healthcare Scholar Program.
References (43)
- et al.
Patient Empowerment and its neighbours: clarifying the boundaries and their mutual relationships
Health Policy
(2015) Intrinsic and extrinsic factors affecting patient engagement in diabetes self-management: perspectives of a certified diabetes educator
Clin. Ther.
(2013)- et al.
Making the most of your healthcare intervention for older adults with multiple chronic illnesses
Patient Educ. Couns.
(2010) Development and validation of an instrument to measure nurse-patient bonding
Int. J. Nurs. Stud.
(2010)- et al.
Patient-centered applications: use of information technology to promote disease management and wellness a white paper by the AMIA knowledge in motion working group
J. Am. Med. Inform. Assoc.
(2008) - et al.
A user-centered model for designing consumer mobile health (mHealth) applications (apps)
J. Biomed. Inform.
(2016) - et al.
Mobile health technology evaluation: the mHealth evidence workshop
Am. J. Prev. Med.
(2013) Expanding Patient-Centered Care To Empower Patients and Assist Providers: Research in Action
(2002)- et al.
Survey shows that fewer than a third of patient-centered medical home practices engage patients in quality improvement
Health Aff. (Millwood)
(2013) - et al.
Continuous patient engagement in comparative effectiveness research
JAMA
(2012)
Patient engagement in the inpatient setting: a systematic review
J. Am. Med. Inform. Assoc.
Framework to assess the effects of using patient-reported outcome measures in chronic care management
Qual. Life Res.
Patient involvement in patient safety: what factors influence patient participation and engagement?
Health Expect.
UnitedHealthcare experience illustrates how payers can enable patient engagement
Health Aff. (Millwood)
Engage your patients electronically
Clin. Neurol. News
Assessing mHealth: opportunities and barriers to patient engagement
J. Health Care Poor Underserved
Patient Engagement: Blockbuster Drug or Snake Oil?
Electronic Health Record Incentive Program
Patient engagement-what works?
J. Ambul. Care Manage.
Concept Analysis: An Evolutionary View, Concept Development in Nursing: Foundations, Techniques, and Applications
Crossing the Quality Chasm: A New Health System for the 21 St Century
Cited by (157)
Building Partnerships to Improve Health Outcomes: Pediatric Patient and Family Engagement in Nephrology Practice
2024, Advances in Kidney Disease and HealthPatient and family perceptions of a discharge bedside board
2023, PEC InnovationCollaboration and Partnership in a 5-Level Engagement Framework for Diabetic Foot Ulcer Management: A Patient-oriented Scoping Review
2023, Canadian Journal of DiabetesNovel Application of Dot Survey Methodology at a Youth Health Clinic: A Pilot Study
2023, Journal of Adolescent HealthPatient Engagement in Neuroradiology: A Narrative Review and Case Studies
2024, American Journal of Neuroradiology