Patient Activation Changes as a Potential Signal for Changes in Health Care Costs: Cohort Study of US High-Cost Patients

go back to reference Blumenthal D, Chernof B, Fulmer T, Lumpkin J, Selberg J. Caring for High-Need, High-Cost Patients — An Urgent Priority. N Engl J Med. 2016;375(10):909–911. doi:https://doi.org/10.1056/NEJMp1608511.CrossRefPubMed Blumenthal D, Chernof B, Fulmer T, Lumpkin J, Selberg J. Caring for High-Need, High-Cost Patients — An Urgent Priority. N Engl J Med. 2016;375(10):909–911. doi:https://​doi.​org/​10.​1056/​NEJMp1608511.CrossRefPubMed

go back to reference Zulman DM, Pal Chee C, Ezeji-Okoye SC, et al. Effect of an Intensive Outpatient Program to Augment Primary Care for High-Need Veterans Affairs Patients. JAMA Intern Med. 2016;5(4):e007771. doi:https://doi.org/10.1001/jamainternmed.2016.8021.CrossRef Zulman DM, Pal Chee C, Ezeji-Okoye SC, et al. Effect of an Intensive Outpatient Program to Augment Primary Care for High-Need Veterans Affairs Patients. JAMA Intern Med. 2016;5(4):e007771. doi:https://​doi.​org/​10.​1001/​jamainternmed.​2016.​8021.CrossRef

go back to reference Hibbard JH, Mahoney ER, Stockard J, Tusler M. Development and testing of a short form of the Patient Activation Measure. Heal Serv Res. 2005;40. doi:https://doi.org/10.1111/j.1475-6773.2005.00438.x.CrossRef Hibbard JH, Mahoney ER, Stockard J, Tusler M. Development and testing of a short form of the Patient Activation Measure. Heal Serv Res. 2005;40. doi:https://​doi.​org/​10.​1111/​j.​1475-6773.​2005.​00438.​x.CrossRef

go back to reference Hibbard JH, Stockard J, Mahoney ER, Tusler M. Development of the Patient Activation Measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Serv Res. 2004;39(4 Pt 1):1005–1026. doi:https://doi.org/10.1111/j.1475-6773.2004.00269.x.CrossRefPubMedPubMedCentral Hibbard JH, Stockard J, Mahoney ER, Tusler M. Development of the Patient Activation Measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Serv Res. 2004;39(4 Pt 1):1005–1026. doi:https://​doi.​org/​10.​1111/​j.​1475-6773.​2004.​00269.​x.CrossRefPubMedPubMedCentral

go back to reference Evangelista LS, Liao S, Motie M, De Michelis N, Lombardo D. On-going palliative care enhances perceived control and patient activation and reduces symptom distress in patients with symptomatic heart failure: a pilot study. Eur J Cardiovasc Nurs. 2014;13(2):116–123. doi:https://doi.org/10.1177/1474515114520766.CrossRefPubMedPubMedCentral Evangelista LS, Liao S, Motie M, De Michelis N, Lombardo D. On-going palliative care enhances perceived control and patient activation and reduces symptom distress in patients with symptomatic heart failure: a pilot study. Eur J Cardiovasc Nurs. 2014;13(2):116–123. doi:https://​doi.​org/​10.​1177/​1474515114520766​.CrossRefPubMedPubMedCentral

go back to reference Salgado TM, Mackler E, Severson JA, et al. The relationship between patient activation, confidence to self-manage side effects, and adherence to oral oncolytics: a pilot study with Michigan oncology practices. Support Care Cancer. 2017:1–11. doi:https://doi.org/10.1007/s00520-017-3584-0.CrossRef Salgado TM, Mackler E, Severson JA, et al. The relationship between patient activation, confidence to self-manage side effects, and adherence to oral oncolytics: a pilot study with Michigan oncology practices. Support Care Cancer. 2017:1–11. doi:https://​doi.​org/​10.​1007/​s00520-017-3584-0.CrossRef

go back to reference Hibbard JH, Mahoney E, Sonet E. Does Patient Activation Level Affect the Cancer Patient Journey? Patient Educ Couns. 2017. doi:https://doi.org/10.1016/j.pec.2017.03.019.CrossRef Hibbard JH, Mahoney E, Sonet E. Does Patient Activation Level Affect the Cancer Patient Journey? Patient Educ Couns. 2017. doi:https://​doi.​org/​10.​1016/​j.​pec.​2017.​03.​019.CrossRef

go back to reference Greene J, Hibbard JH, Sacks R, Overton V, Parrotta CD. When patient activation levels change, health outcomes and costs change, too. Health Aff (Millwood). 2015;34(3):431–437. doi:https://doi.org/10.1377/hlthaff.2014.0452.CrossRefPubMed Greene J, Hibbard JH, Sacks R, Overton V, Parrotta CD. When patient activation levels change, health outcomes and costs change, too. Health Aff (Millwood). 2015;34(3):431–437. doi:https://​doi.​org/​10.​1377/​hlthaff.​2014.​0452.CrossRefPubMed

go back to reference Hibbard JH, Greene J, Sacks R, Overton V, Parrotta CD. Adding A Measure Of Patient Self-Management Capability To Risk Assessment Can Improve Prediction Of High Costs. Health Aff. 2016;35(3):489–494. doi:https://doi.org/10.1377/hlthaff.2015.1031.CrossRef Hibbard JH, Greene J, Sacks R, Overton V, Parrotta CD. Adding A Measure Of Patient Self-Management Capability To Risk Assessment Can Improve Prediction Of High Costs. Health Aff. 2016;35(3):489–494. doi:https://​doi.​org/​10.​1377/​hlthaff.​2015.​1031.CrossRef

go back to reference Hibbard JH, Greene J, Overton V. Patients with lower activation associated with higher costs; delivery systems should know their patients’ “scores”. Health Aff. 2013;32(2):216–222. doi:https://doi.org/10.1377/hlthaff.2012.1064.CrossRef Hibbard JH, Greene J, Overton V. Patients with lower activation associated with higher costs; delivery systems should know their patients’ “scores”. Health Aff. 2013;32(2):216–222. doi:https://​doi.​org/​10.​1377/​hlthaff.​2012.​1064.CrossRef

go back to reference Hibbard JH, Greene J, Sacks RM, Overton V, Parrotta C. Improving Population Health Management Strategies: Identifying Patients Who Are More Likely to Be Users of Avoidable Costly Care and Those More Likely to Develop a New Chronic Disease. Health Serv Res. 2016. doi:https://doi.org/10.1111/1475-6773.12545.CrossRef Hibbard JH, Greene J, Sacks RM, Overton V, Parrotta C. Improving Population Health Management Strategies: Identifying Patients Who Are More Likely to Be Users of Avoidable Costly Care and Those More Likely to Develop a New Chronic Disease. Health Serv Res. 2016. doi:https://​doi.​org/​10.​1111/​1475-6773.​12545.CrossRef

go back to reference Pantely, SE; Lee C. PBGH IOCP Experience Summary. The project described was supported by Grant Number 1C1CMS331047 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies. The research presented here was conducted by the awardee. Findings might or might not be consistent with or confirmed by the findings of the independent evaluation contractor. The data on which this study is based was shared with the researchers for a limited time by agreements between the Centers for Medicare and Medicaid Services, the Pacific Business Group on Health (awardee of the CMS grant) and Stanford School of Medicine. The data will not be available to other researchers. Pantely, SE; Lee C. PBGH IOCP Experience Summary. The project described was supported by Grant Number 1C1CMS331047 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies. The research presented here was conducted by the awardee. Findings might or might not be consistent with or confirmed by the findings of the independent evaluation contractor. The data on which this study is based was shared with the researchers for a limited time by agreements between the Centers for Medicare and Medicaid Services, the Pacific Business Group on Health (awardee of the CMS grant) and Stanford School of Medicine. The data will not be available to other researchers.

go back to reference Duan N. Smearing Estimate: A Nonparametric Retransformation Method. J Am Stat Assoc. 1983;78(383):605–610. doi:https://doi.org/10.1080/01621459.1983.10478017.CrossRef Duan N. Smearing Estimate: A Nonparametric Retransformation Method. J Am Stat Assoc. 1983;78(383):605–610. doi:https://​doi.​org/​10.​1080/​01621459.​1983.​10478017.CrossRef

go back to reference R. Core Team. R: The R Project for Statistical Computing. R. Core Team. R: The R Project for Statistical Computing.

go back to reference Kuznetsova A. Tests in Linear Mixed Effects Models [R package lmerTest version 2.0–33]. Kuznetsova A. Tests in Linear Mixed Effects Models [R package lmerTest version 2.0–33].

go back to reference Greene J, Hibbard JH, Sacks R, Overton V, Parrotta CD. When Patient Activation Levels Change, Health Outcomes And Costs Change, Too. Health Aff. 2015;34(3):431–437. doi:https://doi.org/10.1377/hlthaff.2014.0452.CrossRef Greene J, Hibbard JH, Sacks R, Overton V, Parrotta CD. When Patient Activation Levels Change, Health Outcomes And Costs Change, Too. Health Aff. 2015;34(3):431–437. doi:https://​doi.​org/​10.​1377/​hlthaff.​2014.​0452.CrossRef

go back to reference Hibbard JH, Greene J, Overton V. Patients with lower activation associated with higher costs; Delivery systems should know their Patients’ “Scores”. Health Aff. 2013;32:216–222. doi:https://doi.org/10.1377/hlthaff.2012.1133.CrossRef Hibbard JH, Greene J, Overton V. Patients with lower activation associated with higher costs; Delivery systems should know their Patients’ “Scores”. Health Aff. 2013;32:216–222. doi:https://​doi.​org/​10.​1377/​hlthaff.​2012.​1133.CrossRef

go back to reference Fowles JB, Terry P, Xi M, Hibbard J, Bloom CT, Harvey L. Measuring self-management of patients’ and employees’ health: Further validation of the Patient Activation Measure (PAM) based on its relation to employee characteristics. Patient Educ Couns. 2009;77:116–122. http://www.sciencedirect.com/science/article/pii/S0738399109000949.CrossRef Fowles JB, Terry P, Xi M, Hibbard J, Bloom CT, Harvey L. Measuring self-management of patients’ and employees’ health: Further validation of the Patient Activation Measure (PAM) based on its relation to employee characteristics. Patient Educ Couns. 2009;77:116–122. http://​www.​sciencedirect.​com/​science/​article/​pii/​S073839910900094​9.CrossRef

go back to reference Remmers C, Hibbard J, Mosen DM, Wagenfield M, Hoye RE, Jones C. Is Patient Activation Associated With Future Health Outcomes and Healthcare Utilization Among Patients With Diabetes ? J Ambul Care Manag. 2009;32(4):1–8.CrossRef Remmers C, Hibbard J, Mosen DM, Wagenfield M, Hoye RE, Jones C. Is Patient Activation Associated With Future Health Outcomes and Healthcare Utilization Among Patients With Diabetes ? J Ambul Care Manag. 2009;32(4):1–8.CrossRef

go back to reference Greene J, Hibbard JH, Sacks R, Overton V, Parrotta CD. When patient activation levels change, health outcomes and costs change, too. Health Aff. 2015;34(3):431–437. doi:https://doi.org/10.1377/hlthaff.2014.0452.CrossRef Greene J, Hibbard JH, Sacks R, Overton V, Parrotta CD. When patient activation levels change, health outcomes and costs change, too. Health Aff. 2015;34(3):431–437. doi:https://​doi.​org/​10.​1377/​hlthaff.​2014.​0452.CrossRef

go back to reference Hibbard JH, Greene J, Tusler M. Improving the outcomes of disease management by tailoring care to the patient’s level of activation. Am J Manag Care. 2009;15(6):353–360. .PubMed Hibbard JH, Greene J, Tusler M. Improving the outcomes of disease management by tailoring care to the patient’s level of activation. Am J Manag Care. 2009;15(6):353–360. .PubMed

go back to reference Shively MJ, Gardetto NJ, Kodiath MF, et al. Effect of patient activation on self-management in patients with heart failure. J Cardiovasc Nurs. 2013;28:20–34. doi:https://doi.org/10.1097/JCN.0b013e318239f9f9.CrossRefPubMed Shively MJ, Gardetto NJ, Kodiath MF, et al. Effect of patient activation on self-management in patients with heart failure. J Cardiovasc Nurs. 2013;28:20–34. doi:https://​doi.​org/​10.​1097/​JCN.​0b013e318239f9f9​.CrossRefPubMed

go back to reference Mercer SW, Jani BD, Maxwell M, Wong SYS, Watt GCM. Patient enablement requires physician empathy: a cross-sectional study of general practice consultations in areas of high and low socioeconomic deprivation in Scotland. BMC Fam Pract. 2012;13(1):6. doi:https://doi.org/10.1186/1471-2296-13-6.CrossRefPubMedPubMedCentral Mercer SW, Jani BD, Maxwell M, Wong SYS, Watt GCM. Patient enablement requires physician empathy: a cross-sectional study of general practice consultations in areas of high and low socioeconomic deprivation in Scotland. BMC Fam Pract. 2012;13(1):6. doi:https://​doi.​org/​10.​1186/​1471-2296-13-6.CrossRefPubMedPubMedCentral

go back to reference Hibbard JH, Greene J, Shi Y, Mittler J, Scanlon D. Taking the Long View: How Well Do Patient Activation Scores Predict Outcomes Four Years Later? Med Care Res Rev. 2015;72(3):324. doi:https://doi.org/10.1177/1077558715573871.CrossRefPubMed Hibbard JH, Greene J, Shi Y, Mittler J, Scanlon D. Taking the Long View: How Well Do Patient Activation Scores Predict Outcomes Four Years Later? Med Care Res Rev. 2015;72(3):324. doi:https://​doi.​org/​10.​1177/​1077558715573871​.CrossRefPubMed

go back to reference Reistroffer, Cindy; Hearld, Larry; and Szychowski J. An Examination of the Relationship Between Care Management With Coaching for Activation and Patient Outcomes. Am J Manag Care. 2017;23(2):123–128. Reistroffer, Cindy; Hearld, Larry; and Szychowski J. An Examination of the Relationship Between Care Management With Coaching for Activation and Patient Outcomes. Am J Manag Care. 2017;23(2):123–128.

go back to reference Schoeder S. We Can Do Better — Improving the Health of the American People — NEJM. N Engl J Med. 2007. Schoeder S. We Can Do Better — Improving the Health of the American People — NEJM. N Engl J Med. 2007.