Metrics and Evaluation Tools for Patient Engagement in Healthcare Organization- and System-Level Decision-Making: A Systematic Review

Background Patient, public, consumer, and community (P۲C۲) engagement in organization-, community-, and systemlevel healthcare decision-making is increasing globally, but its formal evaluation remains challenging. To define a taxonomy of possible P۲C۲ engagement metrics and compare existing evaluation tools against this taxonomy, we conducted a systematic review.   Methods A broad search strategy was developed for English language publications available from January ۱۹۶۲ through April ۲۰۱۵ in PubMed, Embase, Sociological Abstracts, PsycINFO, EconLit, and the gray literature. A publication was excluded if: (۱) the setting was not healthcare delivery (ie, we excluded non-health sectors, such as urban planning; research settings; and public health settings not involving clinical care delivery); (۲) the P۲C۲ engagement was episodic; or (۳) the concept of evaluation or possible evaluation metrics were absent. To be included as an evaluation tool, publications had to contain an evaluative instrument that could be employed with minimal modification by a healthcare organization.   Results A total of ۱۹۹ out of ۳۹۵۳ publications met exclusion and inclusion criteria. These were qualitatively analyzed using inductive content analysis to create a comprehensive taxonomy of ۱۱۶ possible metrics for evaluating P۲C۲ engagement. ۴۴ outcome metrics were grouped into three domains (internal, external, and aggregate outcomes) that included six subdomains: impact on engagement participants, impact on services provided by the healthcare organization, impact on the organization itself, influence on the broader public, influence on population health, and engagement cost-effectiveness. The ۷۲ process metrics formed four domains (direct process metrics; surrogate process metrics; aggregate process metrics; and preconditions for engagement) that comprised sixteen subdomains. We identified ۲۳ potential tools for evaluating P۲C۲ engagement. The identified tools were published between ۱۹۷۳-۲۰۱۵ and varied in their coverage of the taxonomy, methodology used (qualitative, quantitative, or mixed), and intended evaluators (organizational leaders, P۲C۲ participants, external evaluators, or some combination). Parts of the metric taxonomy were absent from all tools.   Conclusions By comprehensively mapping potential outcome and process metrics as well as existing P۲C۲ engagement tools, this review supports high-quality P۲C۲ engagement globally by informing the selection of existing evaluation tools and identifying gaps where new tools are needed.   Systematic Review Registration PROSPERO registration number CRD۴۲۰۱۵۰۲۰۳۱۷

Keywords:

Patient Engagement , Patient Participation , Health Systems , Health Planning , Organizational Decision-Making