Patient engagement is an increasingly important component of strategies to reform health care. In this article we review the available evidence of the contribution that patient activation-the skills ...and confidence that equip patients to become actively engaged in their health care-makes to health outcomes, costs, and patient experience. There is a growing body of evidence showing that patients who are more activated have better health outcomes and care experiences, but there is limited evidence to date about the impact on costs. Emerging evidence indicates that interventions that tailor support to the individual's level of activation, and that build skills and confidence, are effective in increasing patient activation. Furthermore, patients who start at the lowest activation levels tend to increase the most. We conclude that policies and interventions aimed at strengthening patients' role in managing their health care can contribute to improved outcomes and that patient activation can-and should-be measured as an intermediate outcome of care that is linked to improved 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.
Patient activation is a term that describes the skills and confidence that equip patients to become actively engaged in their health care. Health care delivery systems are turning to patient ...activation as yet another tool to help them and their patients improve outcomes and influence costs. In this article we examine the relationship between patient activation levels and billed care costs. In an analysis of 33,163 patients of Fairview Health Services, a large health care delivery system in Minnesota, we found that patients with the lowest activation levels had predicted average costs that were 8 percent higher in the base year and 21 percent higher in the first half of the next year than the costs of patients with the highest activation levels, both significant differences. What's more, patient activation was a significant predictor of cost even after adjustment for a commonly used "risk score" specifically designed to predict future costs. As health care delivery systems move toward assuming greater accountability for costs and outcomes for defined patient populations, knowing patients' ability and willingness to manage their health will be a relevant piece of information integral to health care providers' ability to improve outcomes and lower costs.
Patient engagement has become a major focus of health reform. However, there is limited evidence showing that increases in patient engagement are associated with improved health outcomes or lower ...costs. We examined the extent to which a single assessment of engagement, the Patient Activation Measure, was associated with health outcomes and costs over time, and whether changes in assessed activation were related to expected changes in outcomes and costs. We used data on adult primary care patients from a single large health care system where the Patient Activation Measure is routinely used. We found that results indicating higher activation in 2010 were associated with nine out of thirteen better health outcomes-including better clinical indicators, more healthy behaviors, and greater use of women's preventive screening tests-as well as with lower costs two years later. Changes in activation level were associated with changes in over half of the health outcomes examined, as well as costs, in the expected directions. These findings suggest that efforts to increase patient activation may help achieve key goals of health reform and that further research is warranted to examine whether the observed associations are causal.
Highlights • Patient Activation level is associated with cancer patient experiences from diagnosis to survivorship • Less activated cancer patients are more vulnerable to poor experiences and ...outcomes • There is value in assessing patient activation when cancer is diagnosed.
Polyhydramnios, or hydramnios, is an abnormal increase in the volume of amniotic fluid. Identification of polyhydramnios should prompt a search for an underlying etiology. Although most cases of mild ...polyhydramnios are idiopathic, the 2 most common pathologic causes are maternal diabetes mellitus and fetal anomalies, some of which are associated with genetic syndromes. Other causes of polyhydramnios include congenital infection and alloimmunization. The purpose of this document is to provide guidance on the evaluation and management of polyhydramnios. The following are Society for Maternal-Fetal Medicine recommendations: (1) we suggest that polyhydramnios in singleton pregnancies be defined as either a deepest vertical pocket of ≥8 cm or an amniotic fluid index of ≥24 cm (GRADE 2C); (2) we recommend that amnioreduction be considered only for the indication of severe maternal discomfort, dyspnea, or both in the setting of severe polyhydramnios (GRADE 1C); (3) we recommend that indomethacin should not be used for the sole purpose of decreasing amniotic fluid in the setting of polyhydramnios (GRADE 1B); (4) we suggest that antenatal fetal surveillance is not required for the sole indication of mild idiopathic polyhydramnios (GRADE 2C); (5) we recommend that labor should be allowed to occur spontaneously at term for women with mild idiopathic polyhydramnios; that induction, if planned, should not occur at <39 weeks of gestation in the absence of other indications; and that mode of delivery should be determined based on usual obstetric indications (GRADE 1C); and (6) we recommend that women with severe polyhydramnios deliver at a tertiary center due to the significant possibility that fetal anomalies may be present (GRADE 1C).
Abstract Objective The purpose of this study is to begin the process of developing a theory of activation, to inform educational efforts and the design of interventions. Because the experience of ...positive emotions in daily life, tends to widen the individual's array of behavioral responses and increase their openness to new information, we examine how emotions relate to activation levels. Methods A web survey was carried out in 2008 with a National sample of respondents between the ages of 25–75. The study achieved a 63% response rate with a final sample size of 843. Results The findings indicate that activation is linked with the experience of positive and negative emotion in daily life. Those low in activation are weighted down by negative affect and negative self-perception. Conclusions Bringing about change in activation, likely means breaking this cycle of negative self-perception and emotions. Practice implications Experiencing success can start a positive upward cycle, just like failure produces the opposite. By encouraging small steps toward improving health, ones that are realistic, given the individuals level of activation, it is possible to start that positive cycle. Effective educational efforts should focus on improving self-efficacy and the individual's self-concept as a self-manager.
To determine whether an approach that assesses patient capabilities for self-management and then tailors coaching support based on this assessment would be more effective in improving outcomes than ...the usual disease management approach.
A quasi-experimental pre-post design was used, with an intervention group coached with a tailored approach and a control group coached in the usual way.
Data derived from telephonic coaching and from archival utilization data were used in the analysis. Differences in activation scores, clinical indicators, and utilization rates between intervention and control group members were assessed. Propensity scores were used to weigh the data and equalize baseline differences between the intervention and control groups. Analysis of variance repeated measures were used to examine changes over time. This analytic approach assessed whether individual changes over time in the intervention group were significantly different from individual changes over time in the control group.
Overall, the findings showed a consistent picture that indicated a positive impact of the tailored intervention. Activation scores increased, clinical indicators improved, and utilization rates declined to a greater extent in the intervention group than in the control group.
The findings suggest that tailoring coaching to patients' activation level and using the same metric to track progress improves the outcomes of disease management.
Objective. The purpose of this study is to determine whether patient activation is a changing or changeable characteristic and to assess whether changes in activation also are accompanied by changes ...in health behavior.
Study Methods. To obtain variability in activation and self‐management behavior, a controlled trial with chronic disease patients randomized into either intervention or control conditions was employed. In addition, changes in activation that occurred in the total sample were also examined for the study period. Using Mplus growth models, activation latent growth classes were identified and used in the analysis to predict changes in health behaviors and health outcomes.
Data Sources. Survey data from the 479 participants were collected at baseline, 6 weeks, and 6 months.
Principal Findings. Positive change in activation is related to positive change in a variety of self‐management behaviors. This is true even when the behavior in question is not being performed at baseline. When the behavior is already being performed at baseline, an increase in activation is related to maintaining a relatively high level of the behavior over time. The impact of the intervention, however, was less clear, as the increase in activation in the intervention group was matched by nearly equal increases in the control group.
Conclusions. Results suggest that if activation is increased, a variety of improved behaviors will follow. The question still remains, however, as to what interventions will improve activation.
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