A study in the October Journal of General Internal Medicine finds a strong link between patient activation—or having the knowledge, skills, and confidence needed to manage one’s health—and hospital readmissions.
Conducted at Boston Medical Center, the study uses the Patient Activation Measure® (PAM®) developed at the University of Oregon and licensed through Insignia Health and finds that patients with the lowest levels of activation had nearly twice the risk of returning to the hospital within 30 days, compared with patients with the highest levels of activation.
Health care providers nationwide are focused on reducing avoidable hospital readmissions, which many experts say stem from patients not understanding or able to act upon their hospital discharge instructions. Hospitals in the U.S. now face penalties from Medicare and private insurers for high readmission rates, making efforts to identify at-risk patients critical. All told, hospital readmissions within 30 days of discharge cost Medicare an estimated $17.4 billion annually—presenting a major challenge to national efforts to curb health care costs. Last year, more than 2,000 hospitals were penalized by the federal government for their high readmission rates.
“Having the ability to identify patients who are not able to manage their health at the point of discharge is critically important for hospitals,” said Judith Hibbard, DrPh., a professor at the University of Oregon and one of the study’s co-authors, and the lead PAMinventor. “Contrary to what some may assume, patients who demonstrate a lower level of activation do not fall into any specific racial, economic or educational demographics. 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.”
The study reviewed outcomes for nearly 700 patients at Boston Medical Center, an urban academic safety net hospital, using the four levels of patient activation outlined by the PAM model. It showed that participants at the lowest level of activation returned to the hospital with 30 days of discharge at a rate of 1.75 times higher than those at the highest level of patient activation. The findings held true even after removing the effects of illness severity and demographics. The researchers say that screening for patient activation could not only help hospitals identify patients at risk for readmission, but also inform the development of tailored, cost-effective intervention plans. PAM is being used to help patients and clinicians improve care transitions and reduce readmissions in 40 states, called for in the Affordable Care Act.
“This study demonstrates that patient activation is one of the strongest indicators of future behavior and health outcomes,” said Chris Delaney, founder and CEO of Insignia Health. “Hospitals that identify patients with lower activation at the point of discharge—and craft plans for improving their ability to care for themselves—have a major opportunity to reduce their rates of readmitted patients.”
