The impact of patient advisors on healthcare outcomes: a systematic review

Abstract

BackgroundPatient advisory councils are a way for healthcare organizations to promote patient engagement. Despite mandates to implement patient advisory councils through programs like the Patient-Centered Medical Home (PCMH), there is a paucity of data measuring the impact of patients functioning in advisory roles. Our objective is to investigate whether patient engagement in patient advisory councils is linked to improvements in clinical quality, patient safety or patient satisfaction.MethodsWe searched PubMed, SCOPUS, CINAHL and Google Scholar for English language publications between November 2002 to August 2015, using a combination of “patient advisor” and “care outcomes” search terms. Article selection utilized dual screening facilitated by DistillerSR software, with group discussion to resolve discordance. Observational studies, randomized controlled trials, and case studies were included that described patients serving in an advisory role where primary outcomes were mentioned. Reference lists of included studies and grey literature searches were conducted. Qualitative thematic analysis was performed to synthesize results.ResultsDatabase searching yielded 639 articles total after removing duplicates, with 129 articles meeting full text inclusion criteria. 32 articles were identified for final review, 16 of which were case studies. Advisory roles included patient advisory councils, ad-hoc patient committees, community advisory councils, experience-based co-design, and other. Four practice-based studies from one research group, involving community advisors in the design of public health interventions, found improved clinical outcomes. No prospective experimental studies assessed the impact of patient advisors on patient safety or patient satisfaction. One cluster-randomized RCT showed that patient advisors helped health care planning efforts identify priorities more aligned with the PCMH. Ten case studies reported anecdotal benefit to individual patient advisors.ConclusionFive included studies demonstrate promising methods for evaluating patient engagement in healthcare delivery and describe impacts on clinical outcomes and priority setting. Based on the case studies found, patient advisors tend to contribute to patient-facing services that may affect clinical care but are not easily evaluated. As clinics and hospitals implement patient advisory councils, rigorous evaluation of their programs is needed to support the expansion of system-level patient engagement.Trial registrationThis systematic review was registered in the PROSPERO database of the University of York Centre for Reviews and Dissemination (ID: 2015:CRD42015030020).Electronic supplementary materialThe online version of this article (10.1186/s12913-017-2630-4) contains supplementary material, which is available to authorized users.

Who represents me? A patient‐derived model of patient engagement via patient and family advisory councils (PFACs)

“…PFACs are groups of patients, family members and family caregivers who serve as advisors in diverse health‐care settings, from individual clinics and hospitals to entire health systems. PFACs can be seen as part of a broader global movement over the past two decades towards patient and public involvement in health‐care planning …”

“…However, PFACs’ potential may be underutilized. While case studies suggest how PFACs could improve the safety and quality of patient care, systematic and structured reviews have repeatedly demonstrated a lack of rigorous evaluation and evidence of such impact . Much work remains to ensure PFACs can further patient‐ and family‐centred change in diverse health‐care settings …”

Community Education and Engagement in Family Planning: Updated Systematic Review

“…Future work is necessary to establish whether community engagement is primarily an ethical consideration to ensure public health interventions are equitable, versus a means to also ensure interventions are more accessible, user friendly, and effective. There is a small but growing evidence base that patient or consumer involvement can help elicit more patient-centered priorities, educational materials, and communication strategies for general primary care 48–52 ; these assessment methodologies could be adapted to future family planning initiatives.…”

Working with patients to improve care

“…A 2017 systematic review found few robust studies evaluating the impact of patient advisers on health out comes but noted case studies that described improvements in appointment access, patient safety and patient satisfaction. 2 A more recent systematic review found that patient engagement resulted in enhanced care or service delivery, particularly if an organization used methods of codesign. 3 Experiencebased codesign begins with an indepth exploration of the experiences and emotions of patients and then brings patients and staff together to identify and implement improvements in service.…”

“…In some cases, patients who are engaged have improved outcomes themselves. 2 Even though engaging patients to improve services is benefi cial, it is also new for many clinicians and managers. Figure 1 offers suggestions for getting started by listing a range of meth ods that require varying levels of resources from providers and patients.…”