Patient-centered toolkit (PCTK) improves communication between patients, caregivers, and health care team

Health care organizations have been implementing health information technology at increasing rates in an effort to engage patients and caregivers, improve patient satisfaction, and favorably impact outcomes. A new study has found that a novel web-based, patient-centered toolkit (PCTK) used by patients and/or their health care proxies in the hospital setting helped them to engage in understanding and developing their plan of care, and has the potential to improve communication with providers. The results of the study were published in the Journal of the American Medical Informatics Association (2015; doi:10.1093/jamia/ocv093).

The research study, Promoting Respect and Ongoing Safety through Patient-centeredness, Engagement, Communication, and Technology (PROSPECT), gave patients and their caregivers iPads. The iPads provided access to novel tools for participating in their plan of care during hospitalization.

The study was conducted in the medical intensive care (MICU) and oncology units at Brigham and Women's Hospital (BWH) in Boston, Massachusetts. The PCTK provided access to educational content specific to a patient's condition and facilitated patient-provider communication using a novel messaging platform integrated into providers' workflow. In this study, researchers evaluated their enrollment strategy, use and usability of patient tools, and the content of patient-generated messages.

"Doctors and nurses oversee the plan of care, but the patients' goals, priorities, and preferences may not always be effectively conveyed to the clinical care team. Decision-making should be shared among patients, families, and health care providers. We found that this tool widened communication, helping patients and family members partner with health care providers to improve the quality and safety of their care," said lead author Anuj Dalal, MD, a hospitalist in BWH's Division of General Medicine and Primary Care.

Specifically, researchers report that noncritically ill oncology patients were more likely to engage with the PCTK compared with critically ill MICU patients. However, caregivers of critically ill MICU patients often used the PCTK on the patient's behalf.

They learned that patients and caregivers most often used the PCTK to establish goals, view test results and medications, and identify care team members. Additionally, patients and caregivers used the messaging functionality primarily to report health concerns, needs, or preferences, but did not overwhelm providers with too many messages or demand immediate responses.

"Our findings indicate that even with critically ill patients, technology can serve as a helpful mediator to get the provider, patient, and/or caregiver on the same page, working toward a shared goal."

Researchers indicate that more investigation is needed to better understand how to effectively implement this tool within complex hospital settings, including troubleshooting technological issues, and making the PCTK more user-friendly and accessible for patients and caregivers.

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