PATIENT-LEVEL MODELING OF PATIENT ENGAGEMENT STRATEGIES FOR CHRONIC CARE
Author(s)
Bander Balkhi, PharmD, PhD.
Faculty Advisor, King Saud University, Riyadh, Saudi Arabia.
Faculty Advisor, King Saud University, Riyadh, Saudi Arabia.
OBJECTIVES: Chronic care programs increasingly seek to improve outcomes through patient engagement, yet many approaches remain limited to education or adherence support and do not systematically act on patient-reported outcomes (PROs). We specified the ALIGN framework (Alignment of patient engagement, clinical integration, and value-based outcomes) and estimated the impact of alternative engagement strategies on patient-centered outcomes, hospitalization-related utilization, quality-adjusted life years (QALYs), and healthcare costs.
METHODS: An evidence-informed patient-level state-transition model was developed from a healthcare system perspective. The model simulated 100,000 adults over 3 annual cycles and tracked clinical risk, patient activation, adherence, and PRO-measured symptom burden. Four strategies were compared: foundational engagement, behavioral support, PRO-informed clinical decision-making, and full ALIGN implementation. Hospitalization risk was modeled as a function of clinical risk, activation, adherence, and symptom burden, with conditional risk reduction when worsening PROs triggered clinical response. Parameters were informed by published evidence and examined in deterministic scenario analyses varying hospitalization cost, implementation cost, and intervention effectiveness. Outcomes were reported per 10,000 patients.
RESULTS: Compared with foundational engagement, behavioral support reduced hospitalizations by 5.6%, PRO-informed clinical decision-making by 7.0%, and full ALIGN implementation by 14.4%, corresponding to approximately 475 fewer hospitalizations per 10,000 patients over 3 years. Under full ALIGN, high patient activation increased from 20.0% to 65.6%, good adherence from 24.9% to 75.7%, and high symptom burden decreased from 15.9% to 8.4% by year 3. Full ALIGN generated 0.083 QALYs gained per patient and net savings of approximately $3.1 million per 10,000 patients. Savings were primarily driven by avoided hospitalizations and were sensitive to hospitalization-risk reduction and implementation-cost assumptions.
CONCLUSIONS: Engagement strategies combining activation, behavioral support, adherence support, and PRO-informed clinical response may improve patient-centered outcomes and reduce hospitalization-related utilization in chronic care. Findings are exploratory, scenario-based, and should be validated in disease-specific, real-world implementation studies.
METHODS: An evidence-informed patient-level state-transition model was developed from a healthcare system perspective. The model simulated 100,000 adults over 3 annual cycles and tracked clinical risk, patient activation, adherence, and PRO-measured symptom burden. Four strategies were compared: foundational engagement, behavioral support, PRO-informed clinical decision-making, and full ALIGN implementation. Hospitalization risk was modeled as a function of clinical risk, activation, adherence, and symptom burden, with conditional risk reduction when worsening PROs triggered clinical response. Parameters were informed by published evidence and examined in deterministic scenario analyses varying hospitalization cost, implementation cost, and intervention effectiveness. Outcomes were reported per 10,000 patients.
RESULTS: Compared with foundational engagement, behavioral support reduced hospitalizations by 5.6%, PRO-informed clinical decision-making by 7.0%, and full ALIGN implementation by 14.4%, corresponding to approximately 475 fewer hospitalizations per 10,000 patients over 3 years. Under full ALIGN, high patient activation increased from 20.0% to 65.6%, good adherence from 24.9% to 75.7%, and high symptom burden decreased from 15.9% to 8.4% by year 3. Full ALIGN generated 0.083 QALYs gained per patient and net savings of approximately $3.1 million per 10,000 patients. Savings were primarily driven by avoided hospitalizations and were sensitive to hospitalization-risk reduction and implementation-cost assumptions.
CONCLUSIONS: Engagement strategies combining activation, behavioral support, adherence support, and PRO-informed clinical response may improve patient-centered outcomes and reduce hospitalization-related utilization in chronic care. Findings are exploratory, scenario-based, and should be validated in disease-specific, real-world implementation studies.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
PCR45
Topic
Economic Evaluation, Health Service Delivery & Process of Care, Patient-Centered Research
Topic Subcategory
Patient Engagement
Disease
No Additional Disease & Conditions/Specialized Treatment Areas