A patient and her doctor at Palo Alto Medical Foundation make use of a new “Visit Companion” booklet.

Improving patient engagement, experience with “Open Communication”

By Ming Tai-Seale, PhD, MPH, a senior scientist at Palo Alto Medical Foundation Research Institute in California Effective communication between patients and their health care providers is an essential component of high-quality care. At the Palo Alto Medical Foundation Research Institute in Northern California, we wanted to find innovative ways to improve patient-provider communication from both the patient and provider perspectives. So we developed and tested a program called “Open Communication.” The Palo Alto Medical Foundation (PAMF) is a nonprofit health care organization that serves more than one million patients in Alameda, San Mateo, Santa Clara, and Santa Cruz counties in Northern California. I work at the PAMF Research Institute, where we partner with the PAMF health care delivery system to design and evaluate new ways to improve care for our patients. With the Open Communication project, we wanted to address the fact that it can be overwhelming for patients to remember everything they want to ask their doctor during their visit. We also wanted to create a friendly, comfortable environment for our patients. A key component of that is making sure what matters most to the patient is covered during the visit, and ensuring that the patient and provider are on the same page before the end visit ends. Designing an intervention that works for patients and providers My colleagues from the research institute and I worked closely with PAMF patients, physicians, and clinic staff to design the Open Communication intervention. The approach has three key components:
  1. A Visit Companion booklet for patients to write down the issues or questions that matter to them most, and bring to their doctor visit
  2. A short animated video that encourages patients and providers to communicate openly
  3. Provider communication coaching from a standardized patient instructor on how to use the booklet with their patients
Funding for the project came from the Patient-Centered Outcomes Research Institute (PCORI), which supports research that engages real patients in designing effective health care interventions. The patients on our team provided essential input that helped us design the Visit Companion booklet in a way that would meet patients’ needs and be easy to use. We then implemented Open Communication in two of PAMF’s primary care clinics and measured differences in patient experience against a care-as-usual clinic. I’m happy to report that our evaluation showed that the Open Communication intervention increased patient-reported engagement in care and improved patient experience. We also found that when patients were more engaged in their care, and when physicians had practiced their communication with the standardized patient instructor, experience of physicians and other members of the care team also improved. Making it easy to do the right thing Involving patients in every step of this research has made it more firmly grounded in the frontline of care. With Open Communication, we are conveying the message that patients’ opinions matter. We are also giving patients helpful communication tools, so that doing the right thing—having open communication with their providers—will be the easy thing to do. I invite you to join us in giving this promising approach a try. We developed a free toolkit that you can use to get started with Open Communication in your practice. Please email us at OpenCommunication@pamf.org, and we’ll be happy to send you a copy. You can also learn more in this short video about our project and in a paper we published in the April 2016 issue of Health Affairs (“Enhancing Shared Decision Making Through Carefully Designed Interventions That Target Patient And Provider Behavior”), which you can download for free on PCORI’s website. Dr. Tai-Seale is principal investigator for the Open Communication project. In addition to her role as a senior scientist at the PAMF Research Institute, she also serves as a consulting professor at Stanford School of Medicine Department of Health Research and Policy.

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