What is patient engagement?

Patient engagement is the active involvement of patients in their own healthcare. Engaged patients and their families work together with healthcare providers and make use of available tools and information to make informed decisions and take positive actions regarding their health, well-being and medical care.

Like patient experience, patient engagement has been the subject of healthcare research and policy-making for decades. But its profile has risen dramatically during the past 15 years or so with the electronic health records (EHR) management incentives introduced by the Affordable Care Act and the adoption of digital healthcare technologies.

In fact, the impact of digital technology on patient engagement has been so profound that today, ‘patient engagement’ and ‘digital patient engagement’ are virtually synonymous.

Patient engagement is considered critical component of value-based care (increasing quality of care while reducing costs). Its potential to improve public health and lower healthcare costs is so significant that doctors and journalists frequently refer to patient engagement as ‘the blockbuster drug of the century.’

Patient engagement vs. patient activation

Patient engagement and patient activation are sometimes used interchangeably or even equated by definition. In fact, they are distinct but closely related concepts.

Patient activation is extent to which a patient is able and willing to participate in healthcare-related decision-making, and to involve themselves in their own care management. In other words, patient activation is prerequisite for patient engagement. Activated patients are more able and more likely to be engaged patients.

The components of patient engagement

While details may vary across providers or healthcare systems, a patient engagement initiative typically includes the following components.

On-demand access to health information

Health systems need to provide patients with access to their own health data treatment plans, and to clear and reliable information about health conditions and diseases, available treatment options and interventions, medications, healthy lifestyle habits and more.

Patient education

In the context of patient engagement, patient education includes materials that teach patients how to work more effectively with primary care doctors, specialists and other healthcare professionals in order to obtain relevant information and advocate for themselves throughout their health journeys. For example, the Agency for Healthcare Research and Quality (AHRQ) provides videos doctors can use to educate patients on the importance of asking questions during medical visits, and tip sheets patients can use to make sure they are getting the best possible care.

Patient education may also include teaching patients sources and channels to avoid—e.g. social media, influencer sites, online discussion forums—when seeking medical or healthcare information.

Tools for empowerment

In addition to health information and education, patients need tools that enable collaborative care and healthcare self management. These can run the gamut from simple pill organizers, to home medical devices (such as home blood pressure gauges) to sophisticated monitoring devices that enable patients and caregivers to evaluate patient conditions and propose or take action in real-time.

Providers can also provide patients a channel for communicating with caregivers outside the context of an office or hospital visit. For example, many patient portals (see ‘Digital patient engagement strategies and tools,’ below) typically enable patients to ask physicians non-urgent questions or leave messages.

Shared decision making

In shared decision making patients, doctors and patient family members work together to make healthcare decisions that incorporate doctors’ and clinicians’ knowledge and experience, the latest medical research and best practice, and the patients’ healthcare and treatment goals, life circumstances and preferences.

Shared decision making is foundational to patient engagement and to patient-centered care. Research shows that shared decision making results in better treatment adherence—patient behavior that aligns more closely with treatment plans—which correlates strongly with better health outcomes. In addition, shared decision making improves the care experience for all stakeholders (patients and caregivers) and builds patient trust in specific treatment plans and in health services and providers overall.

Benefits of patient engagement

Healthcare industry experts often list many logical or intuitive potential benefits of patient activation and patient engagement initiatives, including

• Better health outcomes and healthier patients overall
• More effective and cost-effective management of chronic conditions
• Improved patient safety
• Higher quality of care at a lower cost
• More efficient hospital operations
• Greater patient satisfaction
• Improved nurse and clinician retention

Data to support many of these benefits is limited, but at least three benefits are supported by peer reviewed studies or providers’ assessments of their own programs.

Improved health outcomes

Engaged patients are more likely to have regular checkups, seek treatment earlier, take medications as prescribed, attend follow-up appointments, proactively monitor their condition and take preventative health measures, eat well (or follow a specific treatment related diet), and avoid risky behaviors such as smoking, drinking, and recreational drug use.

Not surprisingly, scores of peer reviewed studies link patient engagement and patient activation initiatives with better health outcomes across a range of areas including symptom and pain resolution, recovery from illness and surgery, physiological metrics (e.g. blood pressure, weight management, blood sugar levels) and emotional health. For example:

• A 2015 study found that higher preoperative patient activation correlated with improved pain relief, decreased symptoms, better mental health and greater patient satisfaction following total joint replacement surgery.
• A 2017 report on engaging patients for better prevention found that ‘coordinated care trials that actively engaged patients with chronic disease resulted in significant mortality reductions compared to a control group who only took appropriate medications.’

Improved patient safety

A related benefit is improved patient safety. Engaged patients are more likely to take an active role in monitoring and advocating for their own safety, they can experience fewer medication errors, infections and falls. Data from the World Health Organization (WHO) suggests that patient engagement could reduce the burden of harm to patients by 15%, and that engaged patients experience 17% fewer adverse events.

Government and regulatory organizations, such as AHRQ and the Joint Commission, provide patient education materials healthcare providers can use teach and encourage patients to detect and report potential medication errors, surgical site infections and other adverse events. Patient engagement technologies such as wearables or remote patient monitoring (telemonitoring) can identify potential patient safety issues and alert patients and clinicians faster.

Reduced patient and hospital costs

Proponents of patient engagement initiatives frequently advance logical or intuitive arguments that engaged patients who make smarter decision and better manage their own care are less likely to require hospitalization and costly interventions. Actual studies show dramatic potential for cost savings in at least three areas:

• Fewer emergency room visits. A patient engagement pilot program at a Florida hospital combined patient outreach around medication adherence and appointment attendance to decrease emergency room visits by 25% initially and by more than 34% within two quarters.
• Fewer readmissions. A 2017 study found that engaging family caregivers during patient discharge reduced 90-day readmission rates by 25% and 180-day readmission rates by 24%. In another study conducted earlier this year (2025), cardiac patients engaged in a post-discharge virtual cardiac program were 53% less likely to be readmitted for cardiac issues and 43% less likely to be readmitted for any reason 90 days after discharge.
• Fewer no-shows. Studies have determined that no-shows cost independent physicians an average of USD 200 each, with total losses up to USD $150,000 annually; another study estimated that overall no-shows cost they US healthcare system more than USD $150 billion per year. So it’s notable that in 2024, a patient engagement program at a rural Illinois hospital cut the no-show rate by 40%.

In each case, these results also free up hospital or medical office staff, resources and space to enable care for more patients.

According to the latest data from the American Hospital Association, hospitals today find themselves in an increasingly hostile economic climate where costs are rising faster than inflation, Medicaid and Medicare reimbursements are not keeping pace with costs, and patients with chronic conditions spending more time in the hospital with lower reimbursement payments. Patient engagement figures to be an important tool for fighting these headwinds.

Meeting patient engagement challenges

Healthcare organizations may encounter any number of obstacles to delivering on any or all patient engagement components.

Communication barriers

Common obstacles to effective patient-provider communication include

• Complexity of healthcare information. Accurate healthcare information—descriptions of symptoms, treatments, drug interactions, etc.—can be complex, nuanced and jargonic, raising more questions for patients than it answers. To drive patient engagement healthcare providers need to provide information that’s easy for patients to understand and use confidently, without sacrificing accuracy.
• Language barriers. For patient engagement to be effective and safe, patients must absorb health information and communicate with caregivers using a language in which they are fluent. For patients who are non-native language speakers, in-person or virtual interpretive services are essential, enabling these patients to fully understand treatment options and follow care plans, while also building trust in their care team.

Poor health literacy

The term health literacy is deceptive. Yes, it implies the ability to understand health information. But it’s also about a person or patient’s ability to find and use that information to make better healthcare decisions, and to navigate various health services and resources to obtain the best possible healthcare.

True health literacy includes knowing how to distinguish reliable health information sources from others, how to use digital health tools and resources for research and communication, and how to evaluate mathematical data to compare effectiveness of treatments or understand prognoses.

Data shows that one third of Americans have insufficient health literacy and 9 of 10 struggle with health literacy at one time or another. To help improve patients’ health literacy, healthcare providers can

• Provide user training for portals and digital health tools
• Create infographics, decision trees and other visual aids that help patients understand the meaning of data and the impact of healthcare choices
• Use ‘teach back’ methodology, asking patients to repeat instructions or share their thinking so that providers can ensure understanding or fill comprehension gaps.

Social determinants of health

Social determinants of health—economic status, access to healthcare, access to digital devices and connectivity, family stability, educational background, community safety, cultural attitudes toward doctors and hospitals—can be healthcare ‘double whammies’; they often correlate with acute or chronic conditions, while also presenting significant barriers patient engagement. For example, a person who doesn’t graduate high school is more likely than a high school graduate to have at least one chronic health problem, and is less likely to know about or adopt healthy behaviors that could lessen or eliminate that condition.

Addressing social determinants of health starts with awareness. Healthcare providers need to understand how these factors might be impacting individual patients and the community overall. Simply by asking patients questions about their circumstances and lifestyle—who they live with, what they eat, where they buy food, if they smoke—clinicians can identify potential starting points for patient engagement. Providers can also work with trusted community organizations and institutions to activate and engage patients.

Digital patient engagement strategies and tools

Today, hospitals and healthcare organizations rely increasingly on digital technology to enable and encourage patient participation in healthcare. Many of these technologies have already made a profound difference in healthcare outcomes and cost of care.

Patient portals

A patient portal is a dedicated web site that enables patients to access their healthcare information and related supporting resources, communicate with healthcare providers, schedule and cancel appointments (and appointment reminders), attend virtual appointments and more.

Patient portals are tremendously effective tools for activating patients, enabling any patient with internet access to engage with health information, collaborate with caregivers, find data for decision making and self-manage elements of their care.

Electronic health records (EHR)

EHR is a comprehensive digital version of a patient’s medical history and health data, including diagnoses, allergies, visit notes, immunizations, medications, treatments and outcomes. Unlike a paper record, or chart, EHR can be shared easily across hospitals and medical offices. EHR data can also be integrated into other information sources. For example, integrating EHR data into patient portals provides patients with on-demand access to the same information their doctors, nurses and clinicians have.

Telehealth and telemedicine technology

Now in widespread use since the COVID-19 pandemic, telehealth and telemedicine technology—a combination of digital video, audio and teleconferencing capabilities—enables caregivers and patients to visit virtually when meeting in person is impossible or impractical.

Popular telehealth applications for patient engagement include virtual visiting and consultation, remote patient monitoring, and video translation services (including spoken languages and American or European Sign Language).

Wearables and smart medical devices

Wearables, such as the Apple Watch or other wearable devices that continually monitor patient health, make it easier for patients to monitor physiological metrics. Smart devices can transmit key indicators to physicians and clinicians without patient intervention; some enable clinicians to communicate back to patients with instructions or advice.

In-room and in-office digital devices

Patient engagement shouldn’t stop when patients enter the hospital or doctor’s office. By providing computers, tablets or smart TVs in patient rooms or waiting areas, healthcare providers can give patients and their families on-demand access to patient portals, healthcare apps, educational content, discharge instructions, menus and dietary guides, interpretive services, feedback forms and more.

On-site devices can be especially effective for engaging patients and families with limited or no digital connectivity, language barriers, and other social determinants that restrict or prevent their activation or engagement away from the hospital or office.

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