Patients Engaged in Their Care Have Lower Readmission Rates

Marcia Frellick

October 29, 2013

Patients who lack the knowledge, skills, and confidence to manage their own care after hospital discharge have nearly twice the rate of readmissions as patients with the highest levels of engagement, Boston Medical Center researchers have found.

Suzanne E. Mitchell, MD, from the Department of Family Medicine, Boston University School of Medicine, and the Department of Family Medicine, Dowling 5 South Boston Medical Center, Massachusetts, and colleagues used an abbreviated version of the Patient Activation Measure (PAM), an assessment developed by a team at the University of Oregon in 2004 to measure how actively patients are involved in their healthcare. Among the 8 PAM statements patients responded to were "I have been able to maintain (keep up with) lifestyle changes, like eating right or exercising" and "I know how to prevent problems with my health." Results from the study were published online October 4 in the Journal of General Internal Medicine.

Researchers assigned a PAM level between 1 and 4 (where 4 is the most engaged) to 695 patients at the urban safety net hospital. The breakdown was 67 patients (9.6%) with level 1 scores, 123 (17.7%) with level 2, 193 (27.8%) with level 3, and 312 (44.9%) with level 4.

Compared with highly activated patients (level 4), patients with level 1 PAM scores had readmission rates 1.75 times higher 30 days after discharge. PAM level 2 patients' readmission rates were 1.50 times higher than the most-engaged group.

Fairview Health Services in Minnesota has been using the PAM scores since 2009 throughout its 44 mostly primary care clinics, according to Valerie Overton, CNP, RN, vice president of quality and innovations for Fairview Medical Group.

She told Medscape Medical News that the Boston study adds to a body of evidence, including Fairview data, that shows PAM is significantly related to quality of care and patient experience.

"Healthcare systems really have to pay attention to this kind of data, and we have to begin to find interventions that address both improving patients' sense of activation and engagement as well as interventions that are tailored to where the patient is, so we can better mitigate the risk," Overton said.

Fairview has made changes in light of the scores. For example, if a patient has a low PAM score and is therefore at high risk in transitions, the care coordinators are more likely to offer interventions such as sending a member of the complex care team into a patient's home after discharge or having medications sent straight to a patient's house rather than requiring pick-up at a pharmacy, Overton says.

She notes that PAM score is an important indicator but should be used with other measures to determine postdischarge care plans. Patients with severe heart failure, for instance, will be at high risk on discharge, even with a high PAM score. Still, the score tells a story that transcends racial, economic, or educational demographics.

Judith Hibbard, DrPh., a professor at the University of Oregon, Eugene, one of the study's coauthors and the lead PAM inventor, said in a news release, "No health care provider can reliably eyeball a patient's ability to self-manage after leaving the hospital. That's why it is so important to assess patient activation and use that information in developing care plans."

J Gen Intern Med. Published online October 4, 2013. Abstract

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