Improving Your Person and Family Engagement Metrics in TCPI | Patient-Centered Primary Care Collaborative

Source: Improving Your Person and Family Engagement Metrics in TCPI | Patient-Centered Primary Care Collaborative

The Patient Centered Primary Care Collaborative Support and Alignment Network (PCPCC SAN) was created to assist staff and leaders in Practice Transformation Networks, along with enrolled clinicians, to successfully transform their practices to deliver person and family centered care. In 2017 the TCPI is adopting 6 measures of person and family engagement (PFE).  On this page, we describe the measures and offer links to websites where you can download tools, information, and other educational materials.

“Bite Sized” Exercises and Discussion Prompts to Reinforce Culture

Questions to ask your doctor about patient-centered care

The PCPCC SAN is available to help Practice Transformation Networks and TCPI-enrolled clinicians improve person and family engagement. We offer monthly training events along with our Webinar Library, and the SAN Resource Library that includes one pagers and other information you can use to get started. We will also provide one on one services whenever possible. Our SAN offers:

  • Coaching calls with PFE subject matter experts
  • Virtual trainings and webinars customized for your organization’s needs
  • On-site speaking, training or technical assistance (if available)
  • Helping to establish peer support programs as a person and family engagement strategy
  • Assisting clinicians to develop community partnerships with local YMCAs that promote TCPI goals

Please contact us if you are a PTN or TCPI participant interested in discussing other technical assistance we can provide to you.

Point of Care

1.   Active e-Tool: Does the practice use an e-tool (patient portal or other E-Connectivity technology) that is accessible to both patients and clinicians and that shares information such as test results, medication list, vitals and other information and patient record data?

Resources to support performance improvement:

2.   Shared Decision-Making: Does the practice support shared decision-making by training and ensuring that clinical teams integrate patient-identified goals, preferences, concerns and desired outcomes into the treatment plan (e.g. those based on the individual’s culture, language, spiritual, social determinants, etc.)?

Resources to support performance improvement:

​3.   Patient Activation: Does the practice utilize a tool to assess and measure patient activation?

Patient activation refers to a “patient’s knowledge, skills, ability, and willingness to manage his or her own health and care.” [Health Affairs] Tools to measure patient activation can include the Patient Activation Measure (PAM)*, but it can also include other tools that measure a patients’ willingness and capacity to take on the role of managing their own health and health care. TCPI is striving to achieve patient activation through a broader perspective of care management aligned with the change package.

Resources to support performance improvement:


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