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Patient Activation and 30-Day Post-Discharge Hospital Utilization

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ABSTRACT

BACKGROUND

Patient activation is linked to better health outcomes and lower rates of health service utilization. The role of patient activation in the rate of hospital readmission within 30 days of hospital discharge has not been examined.

METHODS

A secondary analysis using data from the Project RED-LIT randomized controlled trial conducted at an urban safety net hospital. Data from 695 English-speaking general medical inpatient subjects were analyzed. We used an adapted, eight-item version of the validated Patient Activation Measure (PAM). Total scores were categorized, according to standardized methods, as one of four PAM levels of activation: Level 1 (lowest activation) through Level 4 (highest activation). The primary outcome measure was total 30-day post-discharge hospital utilization, defined as total emergency department (ED) visits plus hospital readmissions including observation stays. Poisson regression was used to control for confounding.

RESULTS

Of the 695 subjects, 67 (9.6 %) were PAM Level 1, 123 (17.7 %) were Level 2, 193 (27.8 %) were Level 3, and 312 (44.9 %) were Level 4. Compared with highly activated patients (PAM Level 4), a higher rate of 30-day post-discharge hospital utilization was observed for patients at lower levels of activation (PAM Level 1, incident rate ratio [IRR] 1.75, 95 % CI,1.18 to 2.60) and (PAM Level 2, IRR 1.50, 95 % CI 1.06 to 2.13). The rate of returning to the hospital among patients at PAM Level 3 was not statistically different than patients with PAM Level 4 (IRR 1.30, 95 % CI, 0.94 to 1.80). The rate ratio for PAM Level 1 was also higher compared with Level 4 for ED use alone (1.68(1.07 to 2.63)) and for hospital readmissions alone (1.93 [1.22 to 3.06]).

CONCLUSION

Hospitalized adult medical patients in an urban academic safety net hospital with lower levels of Patient Activation had a higher rate of post-discharge 30-day hospital utilization.

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Acknowledgements

Dr. Mitchell is supported by a mentored clinical scientist award from the Agency for Healthcare Research and Quality (1K08HS019771-01). The REDLIT trial was funded by the National Heart Lung and Blood Institute (NHLBI 1 R01 HL081307-01).

Conflict of Interest

No authors have any conflict of interest to report. Dr. Mitchell is a non-product speaker on health behavior counseling for MERCK & Co.

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Authors and Affiliations

  1. Department of Family Medicine, Boston University School of Medicine, Boston, MA, USA

    Suzanne E. Mitchell MD, MS, Paula M. Gardiner MD, MPH, Ekaterina Sadikova MPH, Jessica M. Martin MA, MPH & Brian W. Jack MD

  2. Institute for Policy Research and Innovation, University of Oregon, Eugene, OR, USA

    Judith H. Hibbard PHD

  3. Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA

    Michael K. Paasche-Orlow MD, MA, MPH

  4. Department of Family Medicine, Dowling 5 South Boston Medical Center, 1 BMC Place, Boston, MA, 02118, USA

    Suzanne E. Mitchell MD, MS

Authors
  1. Suzanne E. Mitchell MD, MS
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  2. Paula M. Gardiner MD, MPH
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  3. Ekaterina Sadikova MPH
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  4. Jessica M. Martin MA, MPH
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  5. Brian W. Jack MD
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  6. Judith H. Hibbard PHD
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  7. Michael K. Paasche-Orlow MD, MA, MPH
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Corresponding author

Correspondence to Suzanne E. Mitchell MD, MS.

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Mitchell, S.E., Gardiner, P.M., Sadikova, E. et al. Patient Activation and 30-Day Post-Discharge Hospital Utilization. J GEN INTERN MED 29, 349–355 (2014). https://doi.org/10.1007/s11606-013-2647-2

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  • DOI: https://doi.org/10.1007/s11606-013-2647-2

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