If one relies on a Google search as a benchmark of interest in a topic, it is now boom time for patient engagement. From a base rate of about 10 mentions a year prior to 2000, the rate is currently running close to 100 000 mentions a year. Yet, there is much to learn about this topic. For example, what does "patient engagement" mean?

For some, "patient-centered and patient-engaged" health care is becoming defined by the mandatory collection of standardized "patient experience measures." For others, patient engagement is broadly defined "confidence building" and "shared decision making." For policy makers and payers, "engagement" might ensure policy goals and improved, less costly outcomes because of personal prevention and self-care.

For this review of patient engagement we have accepted Coulter's proffered definition that patient engagement refers to a set of reciprocal tasks by both individuals and health care workers who "work together to promote and support active patient and public involvement in health and healthcare and to strengthen their influence on healthcare decisions, at both the individual and collective levels" (Coulter, 2011). With this definition in mind, The Journal of Ambulatory Care Management is pleased to offer findings and pragmatic opinions from a wide range of authors who have been engaged with the topic of patient engagement for many years.

The first article "Patient Engagement-What Works?" provides a summary of research in several aspects of "engagement." The author concludes by stating emphatically that contrary to popular belief there is a great deal of published evidence on the likely effectiveness of patient engagement strategies, and there is a compelling case for reviewing and, where necessary, adapting healthcare delivery and practice styles to enable active engagement of patients in planning and shaping their healthcare.

Shared decision making is a method to make sure that the "right thing" is done. In "Shared Decision Making: Informing and Involving Patients to Do the Right Thing in Health Care," the author reviews the importance of preference-sensitive decisions and the patient decision aids that are evolving to help make shared decisions practical. Policy changes at the federal and state level will eventually make active participation of informed patients the rule rather than the exception.

Clinical practice must change to accommodate and support greater patient engagement. Many consider practice redesign into a "medical home" an important step for improving patient engagement. In the next article, the Group Health Cooperative of Puget Sound provides a detailed and practical case study for the development and deployment of the medical home. Although some methods of redesign chosen by Group Health may not apply to all clinical settings, the general principles and lessons are universal.

With the phrase "the medium is the message," McLuhan (1964) argued that technologies are the messages themselves and not just the content of the medium. The same point has been made about patient engagement: it is both a means and an end (Coulter, 2011). In the fourth article of this series called "The Medium Is the (Health) Measure: Patient Engagement Using Personal Technologies," the authors provide case studies of the ways modern information and communication technologies are changing the status quo. The medium is becoming the health measure-and much more.

"International Perspectives on Patient Engagement: Results from the Commonwealth Fund" establishes the current "baseline" for patient engagement across 11 selected nations. What stands out from the analyses are the variation in the facilitators for engagement and the adverse effects of income inequality on engagement. There is clearly much room for improvement.

This series of articles on patient engagement concludes with the combined wisdom from 2 authors who have created widely disseminated programs to support patient engagement in health care (Remmers et al., 2009; Stanford Self-Management Programs, n.d.). On the basis of their extensive experience, they offer some "Do and Don't" observations for their programs-and patient engagement programs in general.

-Angela Coulter, PhD

-Dana Safran, ScD

-John H. Wasson, MD

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