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Mounting Evidence in Favor of Patient Activation

February 7, 2013
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If you’re a fan of the patient engagement movement, I implore you to find your way to Health Affairs at some point in the next few days. In the latest issue, editors of the renowned health policy journal focused their efforts on looking at the patient engagement movement across the country’s landscape, from how the concept is being implemented to exploring its biggest obstacles.

One that struck a chord with me was this particular study from Judith Hibbard, Ph.D., a researcher at the Health Policy Group at the University of Oregon, Jessica Greene, Ph.D., a professor and director of research at the George Washington University School of Nursing, and Valerie Overton, vice president of quality and informatics at the Minneapolis-based Fairview Medical Group. The trio of researchers looked how patient activation can positively influence the cost of healthcare.

Hibbard and her colleagues defined patient activation as “skills and confidence that equip patients to become actively engaged in their healthcare.” As pointed out by the editor-in-chief of Health Affairs in this post, it’s actually an offshoot of patient engagement. Engaged patients are taking an action. Activated patients have an understanding and willingness to manage their healthcare.

Unsurprisingly, Hibbard found that patients with the lowest activation rates had healthcare costs that were 8-to-21 percent higher than the costs of patients with the highest activation level. The team of researchers adjusted for patient differences, such as demographic factors and severity of illness. And even then, activated chronic disease patients were better off than those chronic disease patients that weren’t activated.

To figure out how activated a patient was, Fairview used the Patient Activation Measure, a 22-item survey that assesses patient knowledge, skill, and confidence for self-management. Fairview was the guinea pig for the study, with the researchers analyzing the relationship between patient activation levels and billed care costs for 33,163 patients of the health system.

These findings support the findings of another recent study, backed by the American Association of Retired Persons (AARP). The AARP researchers found that more activated patients were less likely to be readmitted within 30 days, experience a medical error, or suffer a health consequence from poor communication among providers.

As various federal government entities push more patient-driven regulatory policies and initiatives, I’m sure negative feedback is inevitable. There are plenty of excuses for not supporting this movement. For example, the physicians cited in this research effort also from the recent Health Affairs issue use time, a lack of training in communication, and not wanting to give up “traditional decision-making role” as three in particular.

Yet, if we’re looking for the most sensible way to lower costs, than why not start with the patient? It’s one of the concepts behind the Colorado Beacon Consortium’s (CBC) Archimedes IndiGO (from the San Francisco-based Archimedes) project. IndiGO is an innovative decision support tool used by the CBC multiple, independent primary care sites, operating on multiple, independent electronic health records (EHRs) throughout western Colorado. It’s the reason CBC won second place in our aptly named Innovators issue this month.

In fact, Colorado Beacon uses the same Patient Activation Measure cited above in IndiGO. The tool, which also combines patient activation with advanced population health analytics, risk stratification, targeted clinical intervention, has been a huge success for Colorado Beacon.

The results speak for themselves. The excuses do not. With all this in mind, the aforementioned critics and cynics should take away one lasting truth when it comes to patient activation. Knowledge is power. Having the knowledge, skills, and understanding to be engaged in one’s healthcare? That’s potentially life-saving and definitely cost-saving.

Please feel free to respond in the comment section below or on Twitter by following me at @HCI_GPerna



Excellent assessment Gabriel. Patient engagement and activation certainly do play a key role in reducing costs, improving safety and lowering risk. Truly important, if not the most important dynamic of MU and the sustained ROI of electronic medical records.

I don't think however, that providers should expect engagement and activation overnight after deploying tools to help activate patients more in their own care. Similar to assessing the ROI of participating in social media, long term scope and analysis should prevail and not the short term euphoria when providers see patients starting to engage with the tools provided.

Also, it goes without saying that engaged and activated patients are more likely to pass that along to future generations and help healthcare efficiency in the aggregate.