Association Between Patient Activation and Health Care Utilization After Thoracic and Abdominal Surgery

Abstract

IMPORTANCEIncreased patient activation (PA) (ie, knowledge, skills, motivation, confidence to participate in care) may result in improved outcomes, especially in surgical settings.OBJECTIVE To estimate the extent to which PA is associated with 30-day postdischarge unplanned health care utilization after major thoracic or abdominal surgery.DESIGN, SETTING, AND PARTICIPANTS This cohort study was performed at 2 centers of a tertiary care hospital network between October 2017 and January 2019. Adult patients undergoing thoracic or abdominal surgery were included. Of 880 patients assessed for eligibility, 692 were deemed eligible, of whom 34 declined to participate, 1 withdrew consent, and 4 were excluded after consent.EXPOSURES Patient activation was measured immediately after surgery during the initial admission using the Patient Activation Measure (score range, 0-100). Patients were dichotomized into low and high PA groups using previously described thresholds (Patient Activation Measure score, Յ55.1). MAIN OUTCOMES AND MEASURESThe primary outcome was unplanned 30-day postdischarge health care utilization (composite including emergency department and outpatient clinic visits and/or hospital readmission). Secondary outcomes were length of stay, 30-day emergency department visits, 30-day readmissions, and postoperative complications.RESULTS A total of 653 patients admitted for thoracic, general, colorectal, and gynecologic surgery were included in the study (mean [SD] age, 58 [15] years; 369 women [56%]; 366 [56%] had minimally invasive surgery; 52 [8%] had emergency surgery), of which 152 (23%) had a low level of PA. Baseline characteristics were similar between patients with low-and high-level PA. Low PA was associated with unplanned health care utilization (odds ratio [OR], 3.15; 95% CI, 2.05-4.86; P < .001), emergency department visits (OR, 1.64; 95% CI, 1.02-2.64; P = .04), complications (OR, 1.63; 95% CI,; P = .01), and length of stay (adjusted mean difference, 1.19 days; 95% CI, 0.06-2.33; P = .04). Low PA was not associated with a higher risk of readmission (adjusted OR, 1.04; 95% CI, 0.56-1.93; P = .90). CONCLUSIONS AND RELEVANCEIn this study, low level of PA was associated with postdischarge unplanned health care use, hospital stay, and complications after major surgery. Identification of patients with low activation may allow the implementation of interventions to improve health care knowledge and support self-management postdischarge.

Experiences of Using a Self-management Mobile App Among Individuals With Heart Failure: Qualitative Study

“…Empowering and activating patients to manage their chronic disease can increase the quality of life and reduce health care utilization [ 18 , 37 ]. Likewise, persons with low activation levels may be at greater risk of poor health outcomes and unplanned hospital readmissions in persons with chronic disease [ 7 , 38 ]. A study completed in rural heart failure patients found a decreased understanding of their health made the self-management of chronic illness sometimes impossible because of decreased knowledge around illness-related symptoms [ 34 ].…”

“…There is growing evidence that supports patient activation to guide interventions and assist in implementing strategies to activate individuals for self-management [ 4 , 5 ]. Previous studies have linked patient activation with positive health outcomes, such as decreased health care utilization [ 6 , 7 ], reducing symptoms [ 8 , 9 ], and improving quality of life [ 10 ].…”

Evaluating the feasibility of a web-based discharge education programme to improve general surgical patients’ postdischarge recovery: a pilot randomised controlled trial

“…Nonetheless, these findings were exploratory and not adequately powered to support hypothesis testing for effectiveness, although it is plausible a correlation exists between patient activation, self-care ability and unplanned healthcare utilisation from the use of the web-based programme. Other research supports the association between patients’ activation level and improved health behaviours 43 44. The study by Dumitra et al 43 found that patients with low levels of activation were associated with increased postdischarge healthcare use, hospital stay and complications after major surgery.…”

“…Other research supports the association between patients’ activation level and improved health behaviours. 43 44 The study by Dumitra et al 43 found that patients with low levels of activation were associated with increased postdischarge healthcare use, hospital stay and complications after major surgery. Our results illustrate the possibility of the wide benefits of a web-based education, given in addition to standard education provided at the hospital, in improving postoperative outcomes.…”

Experiences of Using a Self-management Mobile App Among Individuals With Heart Failure: Qualitative Study (Preprint)

“…Empowering and activating patients to manage their chronic disease can increase [18,37]. Likewise, persons with low activation levels may be at greater risk of poor health outcomes and unplanned hospital readmissions in persons with chronic disease [7,38]. A study completed in rural heart failure patients found a decreased understanding of their health made the self-management of chronic illness sometimes impossible because of decreased knowledge around illness-related symptoms [34].…”