Recently, I’ve been reflecting on our program to help patients with diabetes better understand their condition so that they can live healthier, happier lives. That’s what we have always wanted for our patients, and yet with chronic conditions it often feels as though we’re running in circles.
We must have accessible, cost-effective, and sustainable ways to deliver diabetes self-management education and support. That’s why we created the Diabetes Engagement and Activation Program (DEAP).
DEAP delivers diabetes education at scale using our patient portal to better educate and engage patients in diabetes self-management. Many diabetes intervention programs are costly, time-consuming, or ineffective. We wanted to design something that patients could afford, use, and benefit from. DEAP is built around the American Diabetes Association’s evidence-based research. The program consists of nine modules ranging from “Nutritional Management” to “Medications” to “Psychosocial Stresses.” Each module includes multimedia materials, a four-question quiz, and a prompt to assess a patient’s confidence. Patients whose hemoglobin A1c lab result was above 8 were emailed asking whether or not they’d like to participate in the program’s trial run.
The results were stunning: by the end of the program, only four percent of patients felt they were not well-equipped to manage their disease. We improved patient satisfaction and confidence, lowered costs, and used the population health tools built into our patient portal.
One of the greatest takeaways from the program was the incredible, often untapped power of patient portals. Using DEAP as an example, there are great ways that we all can leverage the power of our portal to increase patient engagement and improve health outcomes.
Here are the three key components for a successful, portal-based treatment plan.
Account for Health Literacy
Try to write patient materials in plain language. As a rule of thumb, this is the language you’d use when speaking to a fourth grader. Health literacy is a major problem in America; studies show that only 12 percent of adults possess “adequate” health literacy. This is compounded when patients are encouraged to follow instructions and answer questions about their health. To put it another way, there’s no way you’ll get accurate answers if you ask confusing questions.
Portals can be tricky. We consume media differently when it’s on a screen. Our comprehension goes down by as much as 70 percent. Our attention span plummets. We skim when we should read.
One method to ensure patients are actively engaged and paying attention to the portal is to balance questions with factual information. Think of it as a pop quiz (cue the flashbacks to seventh-grade history class). One way to balance the two is to “check for understanding” by prompting patients to reflect on and summarize the information that is presented.
You can also apply this practice to everyday office visits, too. By asking a patient to explain a term or treatment plan back to you, you can clear up any misconceptions that may cause confusion down the road. Research shows that using the teach-back method can lead to “statistically significant improvement” in “in disease-specific knowledge, adherence, [and] self-efficacy.” The Centers for Disease Control and Prevention even have a guide to “Everyday Words for Public Health Communication.”
Disease affects all kinds of people. Some of our patients learn best by reading, some by listening, some by watching. Address each type of learning preference by offering text, pictures, video, audio, infographics, and any other medium. You may want to break it down even further; consider different types of text: scientific, storytelling, patient testimonies, analogies … the list goes on and on.
With DEAP, we offer e-brochures that mix visual and textual aids to give patients a multifaceted experience. This activates different parts of the brain which has been shown to increase comprehension. Furthermore, we ask questions to help patients actionize information on the spot, synthesize it, and “explain” it back to us via quizzes.
Studies show that between 40 and 80 percent of information presented to patients during office visits is either forgotten immediately afterward or remembered incorrectly. Portals can reduce this loss by letting patients move at their own pace and set aside time when it is convenient and they can focus. They can re-read, Google any advice they’d like more information about, or message their provider for clarification.
Don’t Be Afraid of Automation
Automation is an undeniably powerful tool. As mentioned, because the DEAP protocol is triggered by a patient’s test results, our patient portal can help alleviate some of the work you’d otherwise be tasked with.
Another method of automation that has been used to great effect is low-confidence alerts. When a patient is quizzed after each module, they are asked how confident they feel applying what they just learned. If they aren’t confident, their primary care provider is alerted and offered suggestions such as:
- Call the patient to let them know we received the message.
- If the patient requested help, ask them what they think would help them to better understand and manage the content from the module.
- See if there is any information that you can provide them over the phone.
- Consider offering them an appointment to meet with someone for help.
- Send the patient’s clinician a summary of the call and the action steps.
Though DEAP designed for diabetes, DEAP can serve as an illustration of the often overlooked and underutilized potential of patient portals. Portals can help patients and providers alike, offering patients 24-hour secure online access to health information such as lab results, online scheduling, the ability to pay bills, and more. For providers, these portals are crucial for Meaningful Use because they provide access to clinical summaries, reminders for preventive or follow-up services, and patient-centered educational materials.