Patient engagement significantly improved the quality of care and patient-centred outcomes as well as staff and organizational outcomes. The quality of the outcomes was associated with high-level engagement strategies that are informed by a conceptual framework for patient engagement in health. Our review of the literature also revealed that there is a shortage of high-quality evidence on the impact of patient engagement on patient-centred outcomes. More evidence is needed to identify which, if any, changes in care processes and outcomes from patient engagement are related to improved patient-centred outcomes. More research also needs to be conducted on the extent to which intervention strategies are replicable in different settings, to ensure that learning is generalized beyond the intervention site.
Quality improvement methods used to engage patients and caregivers have led to the development of distinct tools and resources that can be used by clinicians and decision makers in health care settings to engage patients. These tools and resources are in a variety of formats, for example, surveys, checklists, performance indicators, patient-reported outcome measures, mobile applications, patient decision aids, and national guidelines. The tools are designed to guide patient engagement and address issues related to roles, relationships, and expectations. Some are designed to respond to issues identified by patients and families through the use of interactive designs and activities. Training programs are also available to support clinicians and decision makers using these tools and resources. While the tools and resources are widely available, it is important to consider their design, content, methods of use, and the contexts and incentives of use, so that the benefits of these strategies can be realized. We used a two-pronged approach to assess the impact of patient engagement on patient-centred outcomes: (1) researchers conducted a systematic review of quantitative studies published in peer-reviewed journals to identify the outcomes of quality improvement initiatives in which patients were engaged and (2) the COSMID e-initiative enabled patients to complete an online survey to determine how they felt patient engagement impacted on patient-centred outcomes.
The findings of our review also point to the need for education on the impact of patient engagement on outcomes. The positive outcomes reported in the literature do not necessarily translate into a sustainable impact on health outcomes or on the quality of care [26, 27, 85, 86], which is critical given that the expansion of a patient-centered model to improve health services requires a critical mass of evidence demonstrating the effectiveness of the model across a broad range of conditions. We have highlighted what we believe to be the key success factors to encourage further studies to understand this evidence gap. Our review provides a framework for quality improvement initiatives and highlights the positive findings in the literature, and there is a need for more research to understand the conditions under which these findings translate into sustained health outcomes. This is clearly a significant challenge and further work to develop clear guidelines is urgently needed. 827ec27edc