Abstract
Patient engagement in primary care leadership is an important means to involve community voices at community health centers. Federally qualified health centers (FQHCs) are mandated to have patient representation within their governing boards, while practices seeking patient-centered medical home certification receive credit for implementing patient advisory councils (PACs). Our objective was to compare and contrast how community health centers engage patients in clinic management, decision-making and planning within governing boards versus PACs. Qualitative study conducted from August 2016 to June 2017 at community health centers in California, Arizona and Hawaii. We interviewed practice leaders of patient engagement programs at their site. Eligible clinics had patient representatives within their governing board, PAC, or both. We assessed patient demographics, roles and responsibilities of patients participating, and extent of involvement in quality improvement among governing boards versus PACs. We interviewed 19 sites, of which 17 were FQHCs that had governing boards. Of the 17 FQHCs, 11 had also implemented PACs. Two non-FQHC safety-net sites had PACs but did not have governing boards. Governing board members had formal, structured membership responsibilities such as finances and hiring personnel. PAC roles were more flexible, focusing on day-to-day clinic operations. Clinics tended to recruit governing board patient members for their skill set and professional experience; PAC member recruitment focused more on demographic representation of the clinic’s patient population. Both groups worked on quality improvement, but governing boards tended to review clinic performance metrics, while PAC members were involved in specific project planning and implementation to improve clinical outcomes and patient experience. Patient involvement in clinic improvement in CHCs includes higher-level decision-making and governance through mechanisms such as governing boards, as well as engagement in day-to-day practice improvement through PACs. These roles offer differing, but valuable insights to clinic programs and policies.
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Acknowledgements
This research was funded by the Blue Shield of California Foundation grant number P-23885913 and supported in part by the National Center for Advancing Translational Sciences, National Institutes of Health, UCSF-CTSI Grant UL1TR000004, which supported Author 6. The authors are grateful for the interviewees who donated their time as well as additional communication for clarifications and nomination of other interviewers. Thanks to the Center for Care Innovations, the SF Bay CRN (http://accelerate.ucsf.edu/community/sfbaycrn), and the Western Clinicians Network (https://www.westerncliniciansnetwork.org/), who have served as networks for this work as well as a resource for prior work leading to this research question.
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Dr. Sharma and Ms. Willard-Grace have received honoraria for speaking engagements and providing training webinars on the topic of patient engagement in primary care. The other authors have no conflicts of interest to disclose.
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Sharma, A.E., Huang, B., Knox, M. et al. Patient Engagement in Community Health Center Leadership: How Does it Happen?. J Community Health 43, 1069–1074 (2018). https://doi.org/10.1007/s10900-018-0523-z
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DOI: https://doi.org/10.1007/s10900-018-0523-z