A web-based, patient-centered toolkit to engage patients and caregivers in the acute care setting: a preliminary evaluation

Abstract

We implemented a web-based, patient-centered toolkit that engages patients/caregivers in the hospital plan of care by facilitating education and patient-provider communication. Of the 585 eligible patients approached on medical intensive care and oncology units, 239 were enrolled (119 patients, 120 caregivers). The most common reason for not approaching the patient was our inability to identify a health care proxy when a patient was incapacitated. Significantly more caregivers were enrolled in medical intensive care units compared with oncology units (75% vs 32%; P < .01). Of the 239 patient/caregivers, 158 (66%) and 97 (41%) inputted a daily and overall goal, respectively. Use of educational content was highest for medications and test results and infrequent for problems. The most common clinical theme identified in 291 messages sent by 158 patients/caregivers was health concerns, needs, preferences, or questions (19%, 55 of 291). The average system usability scores and satisfaction ratings of a sample of surveyed enrollees were favorable. From analysis of feedback, we identified barriers to adoption and outlined strategies to promote use.

Keywords: acute care patient portal; patient engagement technology; patient-centered care; patient-provider communication; patient/caregiver engagement.

Figure 1:

Patient Tools. Patients and authorized caregivers can access the PCTK using a secure logon process that requires a personal email address and creation of a password at enrollment. We use structured coded data from the electronic health record and infobuttons to support tailoring of self-management education to patients’ diagnoses, problems, test results, and medications. Patients and caregivers can (1) navigate their plan of care (diagnoses/problems, care team goals, schedule); (2) establish recovery goals, input preferences, and rate priorities; (4) access their medications and test results; (5) review validated educational content; (6) identify care team members; (7) submit questions directly to their providers; (8) complete a validated checklist that informs providers of their discharge preparedness; and (9) view tailored safety tips and reminders (eg, fall prevention risk). All patient information (eg, names, clinical data, etc.) is hypothetical.

Figure 2:

Provider Tools—Plan of Care (2a) and Patient Thread (2b). Providers can access the PCTK from clinical applications typically used in the hospital. From the default “Plan of Care” tab ( figure 2 a), providers can quickly view the Patient Plan of Care summary page to (1) review health concerns, overall and daily goals, and care preferences inputted by patients; (2) update problems viewable by patients; (3) update/establish care team goals; and (4) update the patient’s schedule. Providers can identify current care team members (“Care Team”), message with other care team members (“Provider Thread”), and respond to questions and concerns submitted by the patient or authorized caregiver (“Patient Thread,” figure 2 b). The messaging tools are available to providers on mobile devices (iOS, Apple Inc, Cupertino, California; and Android, Google Inc, Mountain View, California). All patient information (eg, names, clinical data, etc.) is hypothetical.

Figure 2:

Provider Tools—Plan of Care (2a) and Patient Thread (2b). Providers can access the PCTK from clinical applications typically used in the hospital. From the default “Plan of Care” tab ( figure 2 a), providers can quickly view the Patient Plan of Care summary page to (1) review health concerns, overall and daily goals, and care preferences inputted by patients; (2) update problems viewable by patients; (3) update/establish care team goals; and (4) update the patient’s schedule. Providers can identify current care team members (“Care Team”), message with other care team members (“Provider Thread”), and respond to questions and concerns submitted by the patient or authorized caregiver (“Patient Thread,” figure 2 b). The messaging tools are available to providers on mobile devices (iOS, Apple Inc, Cupertino, California; and Android, Google Inc, Mountain View, California). All patient information (eg, names, clinical data, etc.) is hypothetical.

Figure 3:

Categories of Use The categories of patient portal pages are listed on the x-axis . The number of page visits per category is enumerated on the y-axis.