Study: People more activated in their care have better health outcomes, lower costs

SAN FRANCISCO — An increase in patient activation can improve health outcomes and lower costs, according to a new study published in the March issue of Health Affairs.



Researchers from the School of Nursing at the George Washington University, University of Oregon and Fairview Medical Group assessed the relationship between changes in a person’s activation level and changes in health outcomes and cost and found they were associated.



“The Patient Activation Measure study is important for two reasons. First, it is the largest, longitudinal study to look at the impact of an individual’s activation levels on both health outcomes and cost; and second, the findings show that activation levels are related to clinical, behavioral and utilization outcomes as well as health care costs,” stated Valerie Overton, VP for quality and innovation at the Fairview Medical Group.



Conducted at Fairview Health Services, a large non-profit health care system in Minnesota, researchers examined activation levels of more than 32,000 adult patients using the Patient Activation Measure score, a metric used to quantify a person’s knowledge, skills and confidence in managing one’s own health and health care. The two-year study found that higher baseline activation levels were predictive of better health outcomes in nine of 13 health indicators, including maintaining high-density lipoprotein and serum triglycerides in a normal range – important clinical outcomes associated with diabetes and heart disease.



In addition, more activated patients had a greater likelihood to obtain potentially life-saving screening tests such as pap smears and mammography as well as avoid a hospitalization or emergency department visit two years after their Patient Activation Measure level was collected, according to the research.



“For accountable care organizations and other delivery systems looking to reduce costs and improve the health of those they care for, this study suggests that patient activation can be a critical pathway to achieving these goals,” stated Judith Hibbard, professor emerita and senior researcher, Health Policy Research Group at the University of Oregon and developer of the Patient Activation Measure. “The greater the activation level, the greater the odds of better outcomes and lower costs,” she added.



The Patient Activation Measure is categorized into four levels with level one being the least engaged and four being the highest. Patients in the study were primarily female, with approximately 4-out-of-5 in the top two levels of activation. Key findings include:

•    People who were at the lowest levels had significantly lower odds of having positive outcomes for seven-of-13 health indicators compared with those who remained at level four in both time periods.

•    Similar patterns appeared when examining the activation levels and billed costs. When people stayed at the highest level of activation over the study period their projected costs were 31 percent lower than for people who stayed at the lowest levels.

•    Costs for people moving up or down levels, also moved in the same direction as their activation level changes. People who moved down from activation level four to three over one year were 14% higher than those who stayed in level four. Those moving from three or four down to levels one or two had projected costs that were 27% higher than those who were in level four both years (lowest average per capita cost $6,411).