Table 1 Descriptions of all patient engagement in U.S. healthcare implementation activities from environmental scan, described using health equity implementation framework domainsa
Data Source | Innovationc | Patient Recipients | Provider/ Staff Recipients | Inner Context and Outer Context | Societal Contextb | Population with Health Disparity?c |
|---|---|---|---|---|---|---|
Articles from Literature Review | ||||||
 Angstman 2009 [41] | Several. Some evidence based (e.g., depression care management). Most were process improvements to clinical care (e.g., Saturday clinic, internet portal for patients) | Primary care patients or parents of patients | Primary care providers and staff | One primary care clinic; Network of clinics in Minnesota | Not specified | Not specified |
 Norman 2013 [42] | Several. Evidence based (e.g., hypertension home monitoring, colorectal cancer screening) | Several | Healthcare providers | Unspecified clinics in Colorado; Single U.S. healthcare system | Not specified | Rural and frontier communities |
 Pérez Jolles 2017 [43] | Parent activation to increase mental health service engagement for youth. Evidence informed. | Parents of youth with mental health needs | Mental health care staff and directors | One mental health clinic in North Carolina | Sociopolitical: (+/-) Values of immigrant cultures affect perception of U.S. health care | Latino families who were less likely to access mental health services. Spanish speaking |
 Tapp 2017 [44] | Shared decision- making toolkit. Evidence based. | Patients with asthma | Healthcare providers | Many types of clinics; Practice based research network and advanced Medicaid network in North Carolina | Not specified | Yes, not specified |
 English 2018 and Dickinson 2020 (same study but articles reported on two separate patient engagement activities) [45, 46] | Cardiovascular prevention strategies (e.g., improving clinical management of aspirin use, blood pressure control). Evidence based. | Primary care patients | Primary care providers | 211 primary care clinics in two U.S. states (Colorado and New Mexico) | (+/-) tracked % of adults who were uninsured, living below poverty level, local unemployment rate, median income, primary care provider shortages; (+) Collaborative funded by Agency for Health care Research and Quality | Not specified. Reported clinics were in diverse racial and socioeconomic patient serving places |
 Barger 2019 [47] | Prescribing primary prophylactic colony stimulating factors. Evidence informed. | Patients receiving myelosuppressive chemotherapy | Physicians | 45 clinics in National Cancer Institute Community Oncology Research Program | Not specified | Not specified |
 Browne 2020 [48] | Transitions of kidney disease care. Evidence base not specified. | Patients with advanced chronic kidney disease | Kidney specialists | One hospital and several smaller clinics | Single healthcare system in Pennsylvania | Not specified |
 Pandhi 2020 [49] | Several, e.g., depression care management, patient service centers, Saturday primary care clinics - some evidence based, most were greater process improvements to clinical care | Patients | Physicians, nurses, QI personnel, clinic managers, medical assistants | 2 primary care clinics in different healthcare systems across U.S. | (+/-) One clinic urban, one clinic rural (+) increasing emphasis on patient engagement by payers (e.g., CMS) | Not specified |
 Pekmezaris 2020 [50] | Home telemonitoring for chronic obstructive pulmonary disease | Patients with chronic obstructive pulmonary disease | Pulmonologists, primary care physicians, geriatricians, respiratory therapists | Pulmonary rehabilitation centers in New York metropolitan area | Not specified | African American and Hispanic patients |
 Gesell 2021 [51] | Post-acute stroke transitional care model. Evidence based | Patients with stroke and transient ischemic attack | Healthcare providers, social service providers, post-acute care coordinator | 40 hospitals in North Carolina | Not specified | Variety of people from urban and rural areas, varied income and education |
Webinars | ||||||
 Fehling et al., 2016 [52] | Several (e.g., traumatic brain injury interventions). Evidence base not specified. | VHA patients | Not specified | Research Centers of Innovation; VHA healthcare system | Not specified | Yes, several |
 LaChappelle et al., 2017 [53] | Several (e.g., pain management). Evidence base not specified. | VHA patients | VHA providers | Geographic regions: Denver, Houston, Iowa City catchment areas; VHA healthcare system | Sociopolitical: (-) Unsure how to disseminate information to policymakers | Yes, several |
 Asch 2018 [54] | HIV testing. Evidence based. | Patients at high risk for HIV | Primary care providers in VHA | Primary care clinics in selected regions in VHA healthcare system | Sociopolitical: (-) Stigma about HIV risk behavior makes it harder to reach people at high HIV risk | Not specified |
 Elwy 2018 [55] | Several. Evidence based not specified. | Several | Several | Implementation research centers; VHA healthcare system | Not specified | Not specified |
Participant Interviews / Observations | ||||||
 Participant Interview 1 | Several (e.g., blood pressure monitoring, colorectal cancer screening). Evidence based. | Several | Clinic and quality improvement leaders; Community health advocates | 12–26 clinics in in Washington, California, Oregon; Single U.S. integrated health care system, Federally Qualified Health Center system, or two Medicaid managed care insurance plans | Economic: (-) Challenges working with insurance payers | Low income |
 Participant Interview 2 | Trauma psychotherapy. Evidence based. | VHA patients exposed to traumatic events | Mental health providers, clinic administrators | Several mental health clinics in one VHA hospital in Massachusetts | Not specified | Not specified |
 Participant Interview 3 | Notification letter informing parents their children were being placed on a treatment waitlist. Not evidence based. | Parents of children with mental health concerns (children were patients) | Mental health providers, administrative assistant | One outpatient mental health clinic; Private university hospital in New York | Economic: (-) Having public insurance made it hard to find other providers, so waitlist notification was even more upsetting to families because they did not have other options. (+) Implementation initiative funded by a health foundation because it would not otherwise be billable by insurance | People of color |
 Participant Interview 4 | Diabetes self-management program. Evidence based. | Latino diabetes patients or those at risk for diabetes | Clinic managers, community health worker, providers | One community clinic in New Mexico; No larger healthcare system | Economic: (+) external funder that valued community engagement | Immigrants, Latino ethnicity, mainly Spanish speaking, mainly low income |
 Participant Interview 5 | Several. Evidence base not specified. | VHA patients | VHA providers and staff | Seven community clinics and three larger hospitals in California; VHA healthcare system | Physical structures: (-) difficult for some to get to meetings due to lack of affordable or easy transport | People of color |
 Participant Interview 6 | Several (substance use or mental health focus). Evidence base not specified. | VHA patients in recovery who used VHA addiction and/or mental health services | VHA providers and staff | Selected clinics in VHA healthcare system | Not specified | Primarily Black and Latino patients |
 Participant Interview 7 | Several. Evidence base not specified. | VHA patients | Not specified | Hospitals and clinics; VHA healthcare system | Sociopolitical: (+) U.S. military culture facilitates teamwork. Economic: (-) Limited financial resources | Not specified |