Journal of General Internal Medicine

, Volume 27, Issue 5, pp 520–526 | Cite as

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

Original Research

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 

Supplementary material

11606_2011_1931_MOESM1_ESM.pdf (76 kb)
ESM 1(PDF 76 kb)

References

  1. 1.
    Wagner EH. Chronic disease management: What will it take to improve care for chronic illness? Eff Clin Pract. 1998;1:2–4.PubMedGoogle Scholar
  2. 2.
    The Center for Medicare and Medicaid Innovation. Pioneer Accountable Care Organization (ACO) model request for application. 2011.Google Scholar
  3. 3.
    Nutting PA, Miller WL, Crabtree BF, et al. Initial lessons from the first national demonstration project on practice transformation to a Patient-Centered Medical Home. Ann Fam Med. 2009;7(3):254–60.PubMedCrossRefGoogle Scholar
  4. 4.
    Casalino LP. Disease management and the organization of physician practice. JAMA. 2005;293(4):485–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Clark N. Management of chronic disease by patients. Annu Rev Publ Health. 2003;24:289–313.CrossRefGoogle Scholar
  6. 6.
    Kilo CM, Wasson JH. Practice redesign and the patient-centered medical home: History, promises, and challenges. Health Aff. 2010;29(5):773–8.CrossRefGoogle Scholar
  7. 7.
    Davis K, Schoenbaum SC, Audet A-M. A 2020 vision of patient-centered primary care. J Gen Intern Med. 2005;20(10):953–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Frosch D, Elwyn G. I believe, therefore I do. J Gen Intern Med. 2011;26(1):2–4.PubMedCrossRefGoogle Scholar
  9. 9.
    Hibbard JH, Mahoney ER, Stock R, et al. Do increases in patient activation result in improved self-management behaviors? Health Serv Res. 2007;42(4):1443–63.PubMedCrossRefGoogle Scholar
  10. 10.
    Friedberg M. Steel Fisher G, Karp M, et al. Physician groups’ use of data from patient experience surveys. J Gen Intern Med. 2011;26(5):498–504.PubMedCrossRefGoogle Scholar
  11. 11.
    Singer S, Shortell SM. Implementing Accountable Care Organizations. JAMA. 2011;306(7):758–9.PubMedCrossRefGoogle Scholar
  12. 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. 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
  14. 14.
    Rask KJ, Ziemer DC, Kohler SA, et al. Patient activation is associated with healthy behaviors and ease in managing diabetes in an indigent population. Diabetes Educat. 2009;35(4):622–30.CrossRefGoogle Scholar
  15. 15.
    Alegria M, Sribney W, Perez D, et al. The role of patient activation on patient-provider communication and quality of care for us and foreign born Latino patients. J Gen Intern Med. 2009;11(24 Suppl 3):534–41.CrossRefGoogle Scholar
  16. 16.
    Skolasky RL, Green AF, Scharfstein D, et al. Psychometric properties of the patient activation measure among multimorbid older adults. Health Serv. Res. 2011;46(2):457–78.PubMedCrossRefGoogle Scholar
  17. 17.
    Mosen DM, Schmittdiel J, Hibbard J, et al. Is patient activation associated with outcomes of care for adults with chronic conditions? J Ambul Care Manage. 2007;30(1):21–9.PubMedGoogle Scholar
  18. 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. 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
  20. 20.
    Hibbard JH, Mahoney ER, Stockard J, et al. Development and testing of a short form of the patient activation measure. Health Serv Res. 2005;40(6p1):1918–30.PubMedCrossRefGoogle Scholar
  21. 21.
    Remmers C, Hibbard J, Mosen DM, et al. Is patient activation associated with future health outcomes and healthcare utilization among patients with diabetes? J Ambul Care Manage. 2009;32(4):320–7.PubMedGoogle Scholar
  22. 22.
    Deen D, Lu W-H, Rothstein D, et al. Asking questions: The effect of a brief intervention in community health centers on patient activation. Patient Educ Couns. 2011;84(2):257–60.PubMedCrossRefGoogle Scholar
  23. 23.
    Hibbard J, Greene J, Tusler M. Improving the outcomes of disease-management by tailoring care to the patient’s level of activation. Am J Manag Care. 2009;15(6):353–60.PubMedGoogle Scholar
  24. 24.
    Frosch DL, Rincon D, Ochoa S, et al. Activating seniors to improve chronic disease care: Results from a pilot intervention study. J Am Geriatr Soc. 2010;58(8):1496–503.PubMedCrossRefGoogle Scholar
  25. 25.
    Alegria M, Polo A, Gao S, et al. Evaluation of a patient activation and empowerment intervention in mental health care. Med Care. 2008;46(3):247–56.PubMedCrossRefGoogle Scholar
  26. 26.
    Post DM, Cegala DJ, Miser WF. The other half of the whole: Teaching patients to communicate with physicians. Fam Med. 2002;34(5):344–52.PubMedGoogle Scholar
  27. 27.
    Adler NE, Newman K. Socioeconomic disparities in health: Pathways and policies. Health Aff. 2002;21(2):60–76.CrossRefGoogle Scholar
  28. 28.
    Isaacs SL, Schroeder SA. Class– the ignored determinant of the nation's health. N Engl J Med. 2004;351(11):1137–42.PubMedCrossRefGoogle Scholar
  29. 29.
    Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42(6):1206–52.PubMedCrossRefGoogle Scholar
  30. 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. 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
  32. 32.
    Ai C, Norton E. Interaction terms in logit and probit models. Econ Lett. 2003;80(1):123–9.CrossRefGoogle Scholar
  33. 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. 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/]
  35. 35.
    Lustria MLA, Cortese J, Noar SM, et al. Computer-tailored health interventions delivered over the web: Review and analysis of key components. Patient Educ Couns. 2009;74(2):156–73.PubMedCrossRefGoogle Scholar
  36. 36.
    Glasgow RE, Wagner EH, Schaefer J, et al. Development and validation of the patient assessment of chronic illness care (PACIC). Med Care. 2005;43(5):436–44.PubMedCrossRefGoogle Scholar
  37. 37.
    Parchman ML, Zeber JE, Palmer RF. Participatory decision making, patient activation, medication adherence, and intermediate clinical outcomes in type 2 diabetes: A Starnet study. Ann Fam Med. 2010;8(5):410–7.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  1. 1.Department of Planning, Public Policy & Management1209 University of OregonEugeneUSA

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