Why Does Patient Activation Matter? An Examination of the Relationships Between Patient Activation and Health-Related Outcomes

Abstract

BACKGROUND: There is a growing awareness that patients should be more active and effective managers of their health and health care. Recent studies have found patient activation-or having the knowledge, skills, and confidence to manage one's health, to be related to health-related outcomes. These studies have often relied on self-reported outcomes and often have used small samples. OBJECTIVE: To examine the degree to which patient activation is related to a broad range of patient health and utilization outcomes in a large, insured population. DESIGN: Cross-sectional study of patients at Fairview Health Services in Minnesota. Data on patient activation and patient outcomes were derived from the electronic health record, abstracted in December 2010. PATIENTS: A total of 25,047 adult patients were included in the analysis. They all had a primary care visit in the prior six months and completed the patient activation measure as part of an office visit. MAIN MEASURES: The key independent measure was the Patient Activation Measure. We examined 13 patient outcomes across four areas: prevention, unhealthy behaviors, clinical indicators, and costly utilization. RESULTS: In multivariate models, patient activation was related to 12 of 13 patient outcomes in the expected direction. For every additional 10 points in patient activation, the predicted probability of having an ED visit, being obese, or smoking was one percentage point lower. The likelihood of having a breast cancer screen or clinical indicators in the normal range (A1c, HDL, and triglycerides) was one percentage point higher. CONCLUSIONS: This cross sectional study finds that patient activation is strongly related to a broad range of health-related outcomes, which suggests improving activation has great potential. Future work should examine the effectiveness of interventions to support patient activation.KEY WORDS: patient activation; patient engagement; health care quality.

Preventing Hospitalizations in Children With Medical Complexity: A Systematic Review

“…Research with chronically ill adults suggests that increased patient activation (ie, the skills, knowledge, confidence and motivation to maintain one' s health and health care) is associated with less ED and hospital use as well as fewer readmissions. [40][41][42] If these findings translate to caregivers of CMC, testing interventions designed to increase caregiver activation and improve care at home may be effective. Additionally, telehealth interventions with nurse chronic illness management have reduced ED use and preventable hospitalizations in elderly and Veterans Affairs patients, 43,44 and such approaches may be germane to CMC receiving care at home.…”

Patient Activation and 30-Day Post-Discharge Hospital Utilization

“…It is conceivable then that for a patient without these skills (i.e., low patient activation) an acute event requiring hospitalization could be sufficiently debilitating to undermine the patient's ability to learn and carry out important self-care duties in the postdischarge setting, resulting in an increased risk of an unplanned return to the hospital. While there have been both prospective and cross-sectional studies associating lower activation scores with higher risk of hospitalization, [13][14][15] there have been no studies linking the activation score with readmissions or with 30-day unplanned readmissions. One Australian study did find higher readmission rates among patients categorized as frequent utilizers of hospital services compared with similar patients with chronic disease self-management support, suggesting a role for patient activation in reducing avoidable readmissions.…”

Predicting Utilization in a Community Health Center: Patient Activation Measure vs Single Item General-Self Rated Health Measure Pilot

“…In a cross sectional evaluation of Predicting utilization with PAM vs. SF-1 25,047 patients in a large health system in Minnesota where PAM questionnaires were administered routinely to primary care patients, lower PAM scores were associated with higher-cost utilization, namely counts of ED visits and hospitalizations. [9] Patients with the lowest levels of activation had billing costs that were 21% higher than patients at the highest level of activation, and PAM scores predicted future costs over the following year. [9] However, in a prospective study of the same population, those with the lowest levels of activation were more likely to have ED visits, but not hospitalizations, compared to those with higher PAM scores.…”

“…[9] Patients with the lowest levels of activation had billing costs that were 21% higher than patients at the highest level of activation, and PAM scores predicted future costs over the following year. [9] However, in a prospective study of the same population, those with the lowest levels of activation were more likely to have ED visits, but not hospitalizations, compared to those with higher PAM scores. [10] This cohort had more patients at the highest level of activation when compared to a national data sample and in a retrospective, cross -sectional, secondary data evaluation of 1180 patients with diabetes from this same population, higher PAM scores were associated with lower all cause hospitalization, defined as total hospital discharges.…”