EXHIBIT 1.

Safety domains addressed by systematic review for which research gaps remain

Safety target or condition	Patient engagement intervention key findings	Readiness for broad-scale adoption	Recommendations for closing research gaps
Anticoagulation management: bleeding, thromboembolism, anticoagulant-related mortality	INR self-monitoring and/or anticoagulant self-titration reduces thromboembolism and mortality, mixed effect on bleeding Self-efficacy intervention reduces thromboembolism and bleeding	High readiness for adoption, but implementation lags behind; limitations include patient and provider readiness, distribution costs, and clinic infrastructure	Delineate barriers to implementation Explore whether anticoagulation evidence is applicable to the self-management of other high-risk medications such as insulin and opioids
Hypoglycemia in diabetes	Self-management education reduces hypoglycemia in people with type 1 diabetes Digital apps/tools: mixed evidence for types 1 and 2 diabetes Patient activation interventions: null impact for type 2 diabetes	Limited readiness for adoption given the mixed evidence base; patient self-management education lacks a reimbursement mechanism	Meta-analyses are needed to explore the safety of digital apps/tools
Medication safety: medication adherence	Positive impact on adherence: medication self-monitoring and self-management; online access to notes; pharmacist education; simplified dosing regimens	High readiness for adoption; safety benefits of patient engagement to support medication adherence are not currently disseminated	Explore caregiver role in supporting medication adherence
Medication safety: pharmacovigilance, other adverse events	Patients’ reports of adverse events and postmarketing medication adverse events are distinct from and more expansive than provider reports	Already implemented in many European countries; US limitations include interoperability between EMRs, the FDA, and pharmaceutical companies	Investigate prospectively whether patients’ reports reduce or prevent adverse events.
Medication safety: medication administration	Effective reduction of administration errors: patient education, patient monitoring	Adequate evidence base; EMR interoperability across prescribers, pharmacy, and home care limits adoption	Home and community-based studies needed Trials should be integrated between community pharmacies and prescribers
Hospital readmissions	Postdischarge symptom self-monitoring and self-management: mixed evidence Patient and family discharge education: mixed evidence Community health worker support: null impact	Moderate readiness for adoption; efficacy is mixed, but postdischarge monitoring may be important for high-risk patients	Explore the role of family education and support Study the roles of health coaches, navigators, and health care workers explicitly for readmission and safety outcomes

source Authors’analysis of major findings from fifty-two articles that met the study’s inclusion criteria. notes A version of the table with full results is available as online appendix exhibit A4 (see note 20 in text). INR is international normalized ratio, which is the lab test necessary to monitor warfarin for anticoagulation. EMR is electronic medical record. FDA is Food and Drug Administration.