Involving patients in setting priorities for healthcare improvement: a cluster randomized trial.

BACKGROUND: Patients are increasingly seen as active partners in healthcare. While patient involvement in individual clinical decisions has been extensively studied, no trial has assessed how patients can effectively be involved in collective healthcare decisions affecting the population. The goal of this study was to test the impact of involving patients in setting healthcare improvement priorities for chronic care at the community level. DESIGN: Cluster randomized controlled trial. Local communities were randomized in intervention (priority setting with patient involvement) and control sites (no patient involvement). SETTING: Communities in a canadian region were required to set priorities for improving chronic disease management in primary care, from a list of 37 validated quality indicators. INTERVENTION: Patients were consulted in writing, before participating in face-to-face deliberation with professionals. CONTROL: Professionals established priorities among themselves, without patient involvement. PARTICIPANTS: A total of 172 individuals from six communities participated in the study, including 83 chronic disease patients, and 89 health professionals. OUTCOMES: The primary outcome was the level of agreement between patients' and professionals' priorities. Secondary outcomes included professionals' intention to use the selected quality indicators, and the costs of patient involvement. RESULTS: Priorities established with patients were more aligned with core generic components of the Medical Home and Chronic Care Model, including: access to primary care, self-care support, patient participation in clinical decisions, and partnership with community organizations (p < 0.01). Priorities established by professionals alone placed more emphasis on the technical quality of single disease management. The involvement intervention fostered mutual influence between patients and professionals, which resulted in a 41% increase in agreement on common priorities (95%CI: +12% to +58%, p < 0.01). Professionals' intention to use the selected quality indicators was similar in intervention and control sites. Patient involvement increased the costs of the prioritization process by 17%, and required 10% more time to reach consensus on common priorities. CONCLUSIONS: Patient involvement can change priorities driving healthcare improvement at the population level. Future research should test the generalizability of these findings to other contexts, and assess its impact on patient care. TRIAL REGISTRATION: The Netherlands National Trial Register #NTR2496.

Target for improvement: a cluster randomised trial of public involvement in quality-indicator prioritisation (intervention development and study protocol).

BACKGROUND: Public priorities for improvement often differ from those of clinicians and managers. Public involvement has been proposed as a way to bridge the gap between professional and public clinical care priorities but has not been studied in the context of quality-indicator choice. Our objective is to assess the feasibility and impact of public involvement on quality-indicator choice and agreement with public priorities. METHODS: We will conduct a cluster randomised controlled trial comparing quality-indicator prioritisation with and without public involvement. In preparation for the trial, we developed a 'menu' of quality indicators, based on a systematic review of existing validated indicator sets. Participants (public representatives, clinicians, and managers) will be recruited from six participating sites. In intervention sites, public representatives will be involved through direct participation (public representatives, clinicians, and managers will deliberate together to agree on quality-indicator choice and use) and consultation (individual public recommendations for improvement will be collected and presented to decision makers). In control sites, only clinicians and managers will take part in the prioritisation process. Data on quality-indicator choice and intended use will be collected. Our primary outcome will compare quality-indicator choice and agreement with public priorities between intervention and control groups. A process evaluation based on direct observation, videorecording, and participants' assessment will be conducted to help explain the study's results. The marginal cost of public involvement will also be assessed. DISCUSSION: We identified 801 quality indicators that met our inclusion criteria. An expert panel agreed on a final set of 37 items containing validated quality indicators relevant for chronic disease prevention and management in primary care. We pilot tested our public-involvement intervention with 27 participants (11 public representatives and 16 clinicians and managers) and our study instruments with an additional 21 participants, which demonstrated the feasibility of the intervention and generated important insights and adaptations to engage public representatives more effectively. To our knowledge, this study is the first trial of public involvement in quality-indicator prioritisation, and its results could foster more effective upstream engagement of patients and the public in clinical practice improvement. TRIAL REGISTRATION: NTR2496 (Netherlands National Trial Register, http://www.trialregister.nl).

Desarrollo de la acción y el compromiso intersectorial / Action development and intersectorial commitment

Este documento está concebido como herramienta para las IESP, a fin de estimularles el pensamiento, la discusión y la acción sobre su función en el desarrollo de la acción intersectorial. Resume las bases para la acción intersectorial. Aporta una síntesis de lo que es la acción intersectorial (la definición); lo que incluye (los componentes esenciales) y lo que implica (las condiciones para el éxito), Sugiere las formas como las IESP pueden fomentar y apoyar la acción intersectorial. Señala que los retos para estas instituciones son tanto teóricas como prácticas. Incluye, mediante la investigación, el desarrollo de una base de conocimiento para mejorar la acción y el compromiso intersectorial. También, incluye la transferencia y utilización de este conocimiento mediante la educación, el adiestramiento, la actividad comunitaria directa y la cooperación técnica