Metrics and evaluation tools for patient engagement in healthcare organization-and system-level decision-making: A systematic review

Vadim Dukhanin, Rachel Topazian, Matthew Decamp

Research output: Contribution to journalReview articlepeer-review

17 Scopus citations


Background: Patient, public, consumer, and community (P2C2) engagement in organization-, community-, and system-level healthcare decision-making is increasing globally, but its formal evaluation remains challenging. To define a taxonomy of possible P2C2 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 1962 through April 2015 in PubMed, Embase, Sociological Abstracts, PsycINFO, EconLit, and the gray literature. A publication was excluded if: (1) 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); (2) the P2C2 engagement was episodic; or (3) 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 199 out of 3953 publications met exclusion and inclusion criteria. These were qualitatively analyzed using inductive content analysis to create a comprehensive taxonomy of 116 possible metrics for evaluating P2C2 engagement. 44 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 72 process metrics formed four domains (direct process metrics; surrogate process metrics; aggregate process metrics; and preconditions for engagement) that comprised sixteen subdomains. We identified 23 potential tools for evaluating P2C2 engagement. The identified tools were published between 1973-2015 and varied in their coverage of the taxonomy, methodology used (qualitative, quantitative, or mixed), and intended evaluators (organizational leaders, P2C2 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 P2C2 engagement tools, this review supports high-quality P2C2 engagement globally by informing the selection of existing evaluation tools and identifying gaps where new tools are needed.

Original languageEnglish (US)
Pages (from-to)889-903
Number of pages15
JournalInternational Journal of Health Policy and Management
Issue number10
StatePublished - Oct 2018


  • Health planning
  • Health systems
  • Organizational decision-making
  • Patient engagement
  • Patient participation

ASJC Scopus subject areas

  • Leadership and Management
  • Health(social science)
  • Health Policy
  • Management, Monitoring, Policy and Law
  • Health Information Management


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