Why Does Patient Activation Matter? An Examination of the Relationships Between Patient Activation and Health-Related Outcomes
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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.
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.
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.
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.
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.
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.
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 WORDSpatient activation patient engagement health care quality
We would like to thank Fairview Health Services for their support of conducting this research study. Specifically, we would like to thank Valerie Overton, Patricia Lutz, and Scott Johnson for their ongoing help, commitment, and good spirits throughout the research process. In addition, we would like to acknowledge the editor’s very helpful comments and recommendations for the paper, as well as those of the three anonymous reviewers. This research was supported by a grant from the Commonwealth Fund. An earlier version of this paper was presented at the 2011 AcademyHealth Conference in Seattle, WA.
Conflicts of Interest
Jessica Greene has no potential conflict of interest to disclose. Judith Hibbard discloses a potential conflict of interest with her ownership stake in and consultancy with Insignia Health LLC.
- 2.The Center for Medicare and Medicaid Innovation. Pioneer Accountable Care Organization (ACO) model request for application. 2011.Google Scholar
- 12.Hibbard JH, Stockard J, Mahoney ER, et al. Development of the patient activation measure (PAM): Conceptualizing and measuring activation in patients and consumers. Health Serv Res. 2004 Aug;39(4) Pt 1:1005–26.Google Scholar
- 13.Hibbard J, Cunningham PJ. How engaged are consumers in their health and health care, and why does it matter? Washington, DC: Center for Studying Health System Change; 2008.Google Scholar
- 18.Greene J, Hibbard J, Tusler M. How much do health literacy and patient activation contribute to older adults' ability to manage their health? Washington, DC: AARP Public Policy Institute; 2005 June. Report No.: Report 2005–05.Google Scholar
- 19.Hibbard JH, Greene J, Becker ER, et al. Racial/ethnic disparities and consumer activation in health. Health Aff. 2008 Sep-Oct;27(5):1442–53.Google Scholar
- 30.National Cholesterol Education Program Expert Panel on Detection E, and Treatment of High Blood Cholesterol in Adults. Detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). National Heart, Lung, and Blood Institute 2001.Google Scholar
- 31.American Diabetes Association. Executive summary: Standards of medical care in diabetes. Diabetes Care. 2011 January 1, 2011;34(Supplement 1):S4-S10.Google Scholar
- 33.Boyle R, AW St Claire, Whittet M, et al. Decrease in smoking prevalence --- Minnesota, 1999--2010. Morbidity and Mortality Weekly. 2011;60(05):138–41.Google Scholar
- 34.Centers for Disease Control and Prevention. Behavioral risk factor surveillance system survey data. 2009 [cited 2011 October 27; Available from: http://apps.nccd.cdc.gov/brfss/]