Engaging health care consumers to improve the quality of care.

BACKGROUND: Researchers and policy makers have focused on informed choice as the primary role for consumers in improving care. Consumers may play two other roles in improving quality--by being active participants in their care (coproducer role) and by evaluating the care they receive (evaluator role). Enhancing the roles consumers are able to play in the health care system may significantly increase their influence on quality.
OBJECTIVES: To examine the evidence available on the contribution of consumers to quality through the coproducer and evaluator roles. RESEARCH
DESIGN: Conceptual framework and review of the literature.
FINDINGS: Patients who engage in collaborative care, shared decision-making with their providers, and chronic disease self-management have improved health outcomes. Training patients with chronic diseases to self-manage their disease increases functioning, reduces pain, and decreases costs. Developing the evaluator role will support and increase the effectiveness of the other two roles-the informed choice role and the coproducer role.
CONCLUSIONS: Only the informed choice role is being actively promoted for consumers. Increasing the coproducer role would require system and provider change, as well as an increase in consumers' skills and knowledge and a change in their understanding of their appropriate role. Harnessing the power of consumers to create change will depend on the degree to which all these roles are encouraged and supported.