Do your patient education programs pull their weight?
Do your patient education programs pull their weight?
How to assess effect of education on outcomes
By Patrice Spath, ART, BA
Consultant in Health Care Quality and Resource Management
Forest Grove, OR
Preventing and controlling illness requires that patients actively participate in their own care. To encourage such involvement, many hospitals have developed and implemented programs to educate and support patients and their families. The goals of these programs range from providing specific information about postoperative recovery to improving long-term compliance with treatment regimens. A wide variety of media (e.g., print, video, and personal communication) are used to achieve these goals.
Because patient education programs are expensive in terms of financial and human resources, it’s important to ask whether they’ve resulted in a positive return on investment. To make that determination, you must first measure the long-term effect of education on patients’ knowledge, behaviors, attitudes, and skills required to maintain or improve their health. Such factors often determine a patient’s willingness and ability to comply with a treatment regimen and self-manage his or her condition. Of course, these outcomes can be affected by several factors, many of which are unrelated to the amount and quality of education the patient receives.
What changes would you like to see?
Before measuring outcomes, determine what patients are expected to learn from the educational experience. More importantly, what changes would you like to see in the patient as a result of training? Traditional education-related outcomes for a surgical admission are immediate outcomes that can be measured during or promptly after the intervention. (See Figure 1, p. 52.) The nurse or caregiver responsible for providing the patient and/or family with the education is usually the one responsible for recording whether or not the outcomes were achieved prior to the patient’s discharge.
Issues to consider when designing an education-related long-term outcome study include choosing the appropriate endpoints to clearly measure the program’s clinical outcomes, health-related quality of life, patient satisfaction, and changes in health care costs. (See Figure 2 for examples of long-term outcomes that may be affected by patient and family education programs, p. 52.)
• Clinical outcomes.
The impact of patient education on clinical outcomes can be measured in a number of ways. Many interventions can improve patients’ compliance with their medication regimen and medical follow-up care. Clinical outcomes also can be enhanced by improving the quality of physician-patient interaction.
Lifestyle management plays clinical role
When patients learn how to have a meaningful discussion with their physician, they are more likely to provide timely reports of their illness symptoms or adverse reactions. This minimizes the likelihood that the patient will discontinue therapy without first contacting his or her physician. Clinical outcomes also can improve significantly when the quality of patient self-care improves. Lifestyle management plays an important role in reducing risk in conditions such as cardiovascular disease, and in improving treatment of conditions like congestive heart failure (CHF).
• Health-related quality of life.
Health-related quality of life measures generally address patients’ perceptions of their physical functioning, social functioning, role functioning, mental health, vitality, pain, and cognitive functioning. In many cases, improvements in health-related quality of life are a natural result of improved clinical outcomes.
Nevertheless, patients’ perception of their quality of life also improves when they are empowered by well-designed educational programs. Empowered patients tend to feel more personally capable of positively affecting their outcomes. For patients with chronic conditions, health-related quality of life can improve significantly when they are trained in self-management techniques and empowered with education.
• Satisfaction with care.
Patients’ satisfaction with the quality of their health care depends, to a great extent, on their relationship with the health care provider. The foundation of this relationship is communication between parties. A recent study conducted by the division of health policy and administration, University of California at Berkeley School of Public Health, San Francisco found that patients who reported that their provider discussed at least one health education topic with them in the last three years were more likely to be satisfied with their physician than were patients who did not.1
General patient satisfaction surveys used by most hospitals may not be sufficiently detailed to provide feedback about educational interventions. A survey designed specifically for measuring patients’ satisfaction with the education provided by caregivers is shown in Figure 3 (see p. 53).
• Costs.
Patient education interventions have been shown to reduce the cost of health care by decreasing patients’ demands on the health care system. Two of the most frequently cited benefits of work-site health-promotion programs are reduced absenteeism and fewer lost work days. According to some estimates, about 80% of all health problems could be treated at home. Effective education programs can prevent minor illness or injury from progressing to the point of needing professional intervention.
Educated patients cope better
Increased patient awareness through education also can result in earlier detection of problems and more timely outpatient intervention, thus decreasing hospitalizations. Finally, chronic-disease patients who have been empowered through patient education programs generally have better coping skills and are less reliant on health care providers.2
Hospital caregivers have long been involved in educating patients and their families. With increased emphasis on managing the continuum of care, it’s time to measure the long-term effects of patient education programs. Properly designed and conducted patient education programs can demonstrate their value by improving patient compliance and comprehension. Appropriate measurement of the value of these programs is critical to their development and overall success.
References
1. Schauffler HH, Rodriguez T, Milstein A. Health education and patient satisfaction. J Fam Pract 1996; 42(1):62-68.
2. Ansell JE, et al. Long-term patient self-management of oral anticoagulation. Arch Intern Med 1995; 155:2185-2189.
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