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APHA Scientific Session and Event Listing

Recorded presentation

David M. Mosen, PhD, MPH, Kaiser Permanente Center for Health Research, 3800 N Interstate Avenue, Portland, OR 97227-1110, 503-335-6637, david.m.mosen@kpchr.org, David Sobel, MD, Kaiser Permanente, 1950 Franklin Street, 13th floor, Oakland, CA CA, and Judith Hibbard, PhD, 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 manager 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 among this population. We examined the relationship of patient activation with the following outcomes: performance of self-management behaviors, medication adherence, and combined asthma-specific emergency department (ED)/hospitalization utilization.

Methods: We examined survey and administrative data for 571 persistent asthmatics enrolled in a staff model HMO. Persistent asthmatics 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. Asthma-specific utilization measures were identified via an electronic medical record. 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 adherence), and any asthma-specific ED/Hospital 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 = 4.12, 95% CI = 2.74 - 6.35) and higher overall medication adherence (OR = 1.52, 95% CI = 1.03 – 2.23).

Conclusions: We found that higher levels of patient activation were independently associated with higher performance of self-management behaviors and overall medication adherence, important process of care measures, but was not significantly associated with reduced ED/hospital utilization. Further research is needed to better understand the association of patient activation with asthma-specific outcome measures and whether incremental improvements in patient activation results in improved health outcomes.

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

• Articulate what is meant by "patient activation"
• Determine whether higher patient activation is associated with improved outcomes for adults with persistent asthma
• Identify next steps in developing a research plan to better understand the association of patient activation with outcomes among adults with persistent asthma

Keywords: Asthma, Quality of Care

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation