Identify patient self-care skills

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Understanding patients’ ability to self-manage is key to understanding the risk of health decline and preventable use, the researchers say.

According to a new study conducted in Health Services Research suggests. These patients who feel incapacitated are also more likely to be hospitalized and to go to the emergency department (ED) for preventable conditions than patients with good self-management skills.

Judith H. Hibbard, PhD, MPH, of the University of Oregon Health Policy Research Group, and her colleagues concluded that understanding patients’ capacity for self-management is key to understanding the risk of health decline and preventable use.

The study explored whether considering a patient’s self-management skills and confidence, predicted by the Patient Activation Measure (PAM), could help healthcare delivery systems identify high-risk patients who could benefit from supportive interventions. The PAM, which was developed in 2004 by Hibbard and colleagues and is commercially available, assigns patients a score from 0 to 100 and groups them into 4 “levels of activation”, Level 1 (low patient activation ) representing the most affected patients. limited self-management skills.

The study retrospectively examined 98,142 patients from Fairview Health Services in Minnesota who had a PAM score recorded in the electronic health record in 2011 and then visited a primary care clinic at least once in 2012, 2013 and 2014. Researchers evaluated the potential of PAM in determining the future burden of chronic disease and hospitalizations or ED visits sensitive to ambulatory care.

At baseline, poor patient self-management (demonstrated by lower patient activation scores) was associated with higher prevalence of chronic conditions, including depression and hypertension, more emergency room visits, and more hospital admissions related to these conditions. After controlling for demographic characteristics and baseline chronic conditions, researchers found that patients with the lowest level of activation at baseline were 25% more likely to develop a new chronic disease in the coming calendar year. compared to patients at the highest level of activation. Two years after baseline, the analysis showed a 31% difference between the lowest and highest activation groups; and 3 years after inclusion, the difference was 21%. The study authors said their findings suggest the enduring predictive value of PAM scores.

Patients with the lowest activation scores at baseline had a 62% higher probability of having an avoidable hospitalization compared to the most activated group 1 year later. Two years later, the difference between the least and most activated groups was 40%, and 3 years later, the difference was still 30%.

The authors said the big picture their findings suggest is that a patient’s activation score (level of self-management skill) helps predict future risk of developing a chronic disease and using care. expensive and avoidable medical treatment. They believe it is possible to increase patients’ levels of activation and help them better manage their health and healthcare.

“When working with low-level arousal patients, healthcare providers should recommend small steps to achieve behavior change,” and not overwhelm them with too much information or too many changes at the time. times, wrote the authors.

Health care delivery systems can stratify populations based on patient activation scores and thereby identify and support patients with limited self-management skills to avoid poor outcomes and unnecessary costs.

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