PURPOSE: To identify rehabilitation providers’ perspectives on barriers and facilitators to patient engagement in postacute care.

BACKGROUND: Despite the increase of postacute care utilization, there has been little improvement in delivering quality care, as indicated by poor patient outcomes. Hip fracture patients are one population known to have poor patient outcomes. Efforts to enhance patient outcomes include care coordination between health care services, patients, caregivers, and the interdisciplinary postacute care team. When patients engage in their own health care, they affect their self-management behaviors, health services use, health care costs, and health outcomes.

DESIGN: A qualitative approach was utilized to gain perceptions of barriers to and facilitators of patient engagement from rehabilitation providers.

PARTICIPANTS: Ninety-nine rehabilitation providers from 13 skilled nursing facilities (SNFs) participated in the focus groups. They included occupational therapists, occupational therapy assistants, physical therapists, and physical therapy assistants. Participants were included in the study if they currently worked at the facility, communicated in English, and were present on the day that the focus group was conducted. Participants were excluded if they were students.

METHOD: Purposive sampling of SNFs in Los Angeles County was done to capture a diverse group of facilities that differed on characteristics known to affect care delivery (e.g., profit status, staffing ratios, and resources). Thirteen focus groups of rehabilitation providers were conducted.

ANALYSIS: Focus groups were audio recorded and transcribed verbatim. A grounded theory approach was used to systematically analyze the transcripts for major themes and subthemes. The social ecological model provided a framework to examine the factors from all levels that influence patient engagement. Codes were developed and the qualitative data analysis software Atlas.ti was used to organize and facilitate data analysis.

RESULTS: Rehabilitation providers’ perspectives of barriers and facilitators to patient engagement were found across all levels of the ecological model: at the intrapersonal level (e.g., disorientation to SNF stay), interpersonal level (e.g., developing rehab goals with patients), facility organization level (e.g., rules and regulations of the facility), and a public policy level (e.g., impact of insurance on patients’ care).

DISCUSSION: Identifying barriers and facilitators to patient engagement within the different levels of the social ecological model can inform both providers and consumers on how patient engagement in postacute care is influenced on different levels. Future research is needed to understand perspectives on patient engagement from different stakeholders, such as patients, caregivers, and nursing staff. Research is also needed to examine how the multiple levels of the ecological model interact to influence patient engagement.

IMPACT STATEMENT: In the context of health care reform and the priorities of the Patient Protection and Affordable Care Act, which emphasized enhancing overall quality of care, patient engagement allows for the delivery of high-quality care. The findings from this study illustrate the factors that influence patient engagement and provide implications for how patient engagement can be facilitated by rehabilitation providers, SNFs, and public policy.