Improving Your Person and Family Engagement Metrics in TCPI

Assistance is available to TCPI clinicians to help improve performance on PFE measures

Improving Your Person and Family Engagement Metrics in the TCPI Program

The Patient Centered Primary Care Collaborative Support and Alignment Network (PCPCC SAN) was created to assist staff and leaders in Practice Transformation Networks, along with enrolled clinicians, to successfully transform their practices to deliver person and family centered care. In 2017 the TCPI is adopting 6 measures of person and family engagement (PFE).  On this page, we describe the measures and offer links to websites where you can download tools, information, and other educational materials.

The PCPCC SAN is available to help Practice Transformation Networks and TCPI-enrolled clinicians improve person and family engagement. We offer monthly training events along with our Webinar Library, and the SAN Resource Library that includes one pagers and other information you can use to get started. We will also provide one on one services whenever possible. Our SAN offers: 

  • Coaching calls with PFE subject matter experts
  • Virtual trainings and webinars customized for your organization’s needs
  • On-site speaking, training or technical assistance (if available)
  • Helping to establish peer support programs as a person and family engagement strategy
  • Assisting clinicians to develop community partnerships with local YMCAs that promote TCPI goals

Please contact us if you are a PTN or TCPI participant interested in discussing other technical assistance we can provide to you. 

TCPI Person and Family Engagement Metrics

Six person and family engagement performance (PFE) metrics have been successfully piloted within TCPI participating practices.  Starting this year, practices participating in TCPI will use the Practice Assessment Tool to establish baseline performance and assess improvements in these metrics. Person and family engagement is considered a "driver" of practice improvements that result in better outcomes and reduced costs, the overall goal of TCPI.

The six TCPI PFE Metrics are grouped into three categories-- Point of Care, Policies and Procedures, and Governance. The metrics are listed below with links to information and supporting resources that may help drive performance improvements in practices. The TCPI Person and Family Engagement Affinity Group developed these six metrics and identified many relevant resources, such as the PFE Compendium linked below. Practices are encouraged to talk with their PTN or contact the PCPCC SAN directly to identify other technical assistance available.

Access the TCPI PFE Resource Compendium and Related Guides here! 

PFE Engagement Metrics


1.   Support for Patient and Family Voices: Are there policies, procedures and actions taken to support patient and family participation in governance or operational decision-making of the practice (Person and Family Advisory Councils, Practice Improvement Teams, Board Representatives, etc.)?

Resources to support performance improvement:

Person and Family Advisory Councils (Some of these curriculum were developed for hospitals, but are applicable to ambulatory practices)

Practice Improvement Teams

Board Representatives

Point of Care

2.   Shared Decision-Making: Does the practice support shared decision-making by training and ensuring that clinical teams integrate patient-identified goals, preferences, concerns and desired outcomes into the treatment plan (e.g. those based on the individual’s culture, language, spiritual, social determinants, etc.)? 

Resources to support performance improvement:

Policy and Procedure

​3.   Patient Activation: Does the practice utilize a tool to assess and measure patient activation?

Patient activation refers to a “patient’s knowledge, skills, ability, and willingness to manage his or her own health and care.” [Health Affairs] Tools to measure patient activation can include the Patient Activation Measure (PAM)*, but it can also include other tools that measure a patients’ willingness and capacity to take on the role of managing their own health and health care. TCPI is striving to achieve patient activation through a broader perspective of care management aligned with the change package.

Resources to support performance improvement:

Point of Care

4.   Active e-Tool: Does the practice use an e-tool (patient portal or other E-Connectivity technology) that is accessible to both patients and clinicians and that shares information such as test results, medication list, vitals and other information and patient record data?

Resources to support performance improvement:

Policy and Procedure

5.    Health Literacy Survey: Is a health literacy patient survey being used by the practice (e.g., CAHPS Health Literacy Item Set)?

Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.

Resources to support performance improvement:

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