Skip to main content
Erschienen in: Journal of General Internal Medicine 5/2012

01.05.2012 | Original Research

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

verfasst von: Jessica Greene, PhD, Judith H. Hibbard, Dr, PH

Erschienen in: Journal of General Internal Medicine | Ausgabe 5/2012

Einloggen, um Zugang zu erhalten

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.
Anhänge
Nur mit Berechtigung zugänglich
Fußnoten
1
The ranges of per capita income in the terciles were $10,618–$22,653, $22,654–$28,606, and $28,607–$69,391. The vast majority (95%) of the patients in the top income tercile lived in zip codes with per capita incomes under $38,583. The results of analyses using quartiles instead of terciles were substantively similar.
 
Literatur
1.
Zurück zum Zitat Wagner EH. Chronic disease management: What will it take to improve care for chronic illness? Eff Clin Pract. 1998;1:2–4.PubMed Wagner EH. Chronic disease management: What will it take to improve care for chronic illness? Eff Clin Pract. 1998;1:2–4.PubMed
2.
Zurück zum Zitat The Center for Medicare and Medicaid Innovation. Pioneer Accountable Care Organization (ACO) model request for application. 2011. The Center for Medicare and Medicaid Innovation. Pioneer Accountable Care Organization (ACO) model request for application. 2011.
3.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
4.
Zurück zum Zitat Casalino LP. Disease management and the organization of physician practice. JAMA. 2005;293(4):485–8.PubMedCrossRef Casalino LP. Disease management and the organization of physician practice. JAMA. 2005;293(4):485–8.PubMedCrossRef
5.
Zurück zum Zitat Clark N. Management of chronic disease by patients. Annu Rev Publ Health. 2003;24:289–313.CrossRef Clark N. Management of chronic disease by patients. Annu Rev Publ Health. 2003;24:289–313.CrossRef
6.
Zurück zum Zitat Kilo CM, Wasson JH. Practice redesign and the patient-centered medical home: History, promises, and challenges. Health Aff. 2010;29(5):773–8.CrossRef Kilo CM, Wasson JH. Practice redesign and the patient-centered medical home: History, promises, and challenges. Health Aff. 2010;29(5):773–8.CrossRef
7.
Zurück zum Zitat Davis K, Schoenbaum SC, Audet A-M. A 2020 vision of patient-centered primary care. J Gen Intern Med. 2005;20(10):953–7.PubMedCrossRef Davis K, Schoenbaum SC, Audet A-M. A 2020 vision of patient-centered primary care. J Gen Intern Med. 2005;20(10):953–7.PubMedCrossRef
9.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
10.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
11.
Zurück zum Zitat Singer S, Shortell SM. Implementing Accountable Care Organizations. JAMA. 2011;306(7):758–9.PubMedCrossRef Singer S, Shortell SM. Implementing Accountable Care Organizations. JAMA. 2011;306(7):758–9.PubMedCrossRef
12.
Zurück zum Zitat 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. 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.
13.
Zurück zum Zitat 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. 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.
14.
Zurück zum Zitat 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.CrossRef 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.CrossRef
15.
Zurück zum Zitat 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.CrossRef 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.CrossRef
16.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
17.
Zurück zum Zitat 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.PubMed 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.PubMed
18.
Zurück zum Zitat 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. 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.
19.
Zurück zum Zitat 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. 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.
20.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
21.
Zurück zum Zitat 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.PubMed 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.PubMed
22.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
23.
Zurück zum Zitat 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.PubMed 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.PubMed
24.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
25.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
26.
Zurück zum Zitat 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.PubMed 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.PubMed
27.
Zurück zum Zitat Adler NE, Newman K. Socioeconomic disparities in health: Pathways and policies. Health Aff. 2002;21(2):60–76.CrossRef Adler NE, Newman K. Socioeconomic disparities in health: Pathways and policies. Health Aff. 2002;21(2):60–76.CrossRef
28.
Zurück zum Zitat Isaacs SL, Schroeder SA. Class– the ignored determinant of the nation's health. N Engl J Med. 2004;351(11):1137–42.PubMedCrossRef Isaacs SL, Schroeder SA. Class– the ignored determinant of the nation's health. N Engl J Med. 2004;351(11):1137–42.PubMedCrossRef
29.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
30.
Zurück zum Zitat 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. 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.
31.
Zurück zum Zitat American Diabetes Association. Executive summary: Standards of medical care in diabetes. Diabetes Care. 2011 January 1, 2011;34(Supplement 1):S4-S10. American Diabetes Association. Executive summary: Standards of medical care in diabetes. Diabetes Care. 2011 January 1, 2011;34(Supplement 1):S4-S10.
32.
Zurück zum Zitat Ai C, Norton E. Interaction terms in logit and probit models. Econ Lett. 2003;80(1):123–9.CrossRef Ai C, Norton E. Interaction terms in logit and probit models. Econ Lett. 2003;80(1):123–9.CrossRef
33.
Zurück zum Zitat 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. 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.
35.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
36.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
37.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
Metadaten
Titel
Why Does Patient Activation Matter? An Examination of the Relationships Between Patient Activation and Health-Related Outcomes
verfasst von
Jessica Greene, PhD
Judith H. Hibbard, Dr, PH
Publikationsdatum
01.05.2012
Verlag
Springer-Verlag
Erschienen in
Journal of General Internal Medicine / Ausgabe 5/2012
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-011-1931-2

Weitere Artikel der Ausgabe 5/2012

Journal of General Internal Medicine 5/2012 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.