Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #115683

David M. Mosen, PhD, MPH¹, Judith Hibbard, PhD², David Sobel, MD¹, and Carol Remmers, MPH¹. (1) Care Management Institute, Kaiser Permanente, 500 NE Multnomah St, Suite 240, Portland, OR 97232, 503-813-3827, david.m.mosen@kpchr.org, (2) Department of Planning, Public Policy & Management, University of Oregon, 1209 University of Oregon, Eugene, OR 97403-1209

Objective: Patient activation refers to an individual's skills and abilities to manage their own health and their ability to engage health providers in shared decision making practices. Such skills are important for the ongoing management of such chronic conditions as persistent asthma. However, little research has examined the relationship of patient activation with health outcomes for adults with diabetes. We examined the relationship of patient activation with the following outcomes: performance of self-management behaviors, medication adherence, and emergency department (ED) utilization.

Methods: We examined survey and administrative data for 1075 diabetics enrolled in a staff model HMO. Diabetics were identified during calendar year 2003 using HEDIS inclusion criteria. In fall 2004, the same patients were surveyed (via mail/telephone) regarding their level of patient activation using a valid and reliable instrument developed by Hibbard and colleagues. A 0-100 composite score was constructed, with zero representing the lowest patient activation and 100 representing the highest. The measure was dichotomized into low activation (0-54) and high activation (55-100). Performance of self-management behaviors and medication adherence were both assessed using valid and reliable subscales. ED utilization was measured via an electronic medical record during calendar year 2004.

Logistic Regression was used to examine the independent association of patient activation on high performance of self-management behaviors (vs. low performance), high medication adherence (vs. low performance), and any ED utilization (vs. no utilization) after adjusting for age, gender, race/ethnicity, educational attainment, functional health status, and geographic location.

Results: After adjusting for demographic factors, functional status, and geographic location, we found that higher patient activation was associated with higher performance of self-management behaviors (OR = 4.85, 95% CI = 3.66 - 6.43), higher medication adherence (OR = 3.11, 95% CI = 1.42 – 6.83), and lower ED utilization (OR = 0.68, 95% CI = 0.49 – 0.93).

Conclusions: We found that higher levels of patient activation were independently associated with higher performance of self-management behaviors and medication adherence, important process of care measures, as well as reduced ED utilization. Further research is needed to better understand the association of patient activation with disease-specific diabetes measures and whether incremental improvements in patient activation results in improved health outcomes for adults with diabetes.

Learning Objectives: At the conclusion of the session, the participant in this session will be able to

• Describe how patient activation is operationalized
• Describe the association of patient activation with performance of self-management behaviors, medication adherence, and ED utilization among adults with diabetes
• Identify policy-implications of patient activation research

Keywords: Self-Management, Diabetes

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation