UC Berkeley

Health care delivery organizations are increasingly being encouraged to implement strategies to engage patients in their health and health care yet have varying capabilities to support patient-centered care. Improving the quality of health care delivery requires a better understanding of the multi-level organizational capabilities that enable patient engagement. This dissertation develops a conceptual framework to delineate the health care system, physician practice, and team factors associated with patient engagement in chronic care.

The first study links clinical data to surveys of patients with diabetes in fourteen community health center sites to examine if the availability of team member expertise is associated with patient experiences of chronic care, and whether the relationship is consistent for small versus large sites. The second study uses a nationally representative survey of physician practices and health systems to clarify how health systems may influence the adoption of patient engagement and chronic care management capabilities in constituent physician practices. The third study utilizes Mokken scale analysis and a survey of adult primary care practices to reveal potential pacing and foundation setting in the adoption of patient engagement strategies.