Effect of Patient Activation on Self-Management in Patients With Heart Failure

Shively, Martha; Gardetto, Nancy; Kodiath, Mary F.; Kelly, Ann E.; Smith, Tom L.; Stepnowsky, Carl; Maynard, Charles; C, Larson

doi:10.1097/jcn.0b013e318239f9f9

Cited by 177 publications

(178 citation statements)

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“…24,25 Studies to date suggest that even when patients have multiple chronic illnesses, are socioeconomically disadvantaged, or are elderly, they can still make gains in activation and exert some measure of control over their day-to-day health. 18,21,[24][25][26] Perhaps the most encouraging finding from intervention studies is that with targeted interventions, patients who are the least activated appear to realize the greatest gains in activation. 18,21,23 Thus, the evidence indicates that focusing on strategies that increase patient activation can be effective in improving patients' health and, very likely, lowering their health care costs.…”

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confidence: 99%

“…18 Interventions that provide peer support for patients and improve their problem-solving skills have also been shown to increase patient activation and improve health outcomes. [20][21][22][23][24][25] Finally, interventions, such as tailored coaching, that customize support to a patient's current level of activation have also been successful in increasing activation, improving health indicators, and reducing costly hospital and emergency department use. 24,25 Studies to date suggest that even when patients have multiple chronic illnesses, are socioeconomically disadvantaged, or are elderly, they can still make gains in activation and exert some measure of control over their day-to-day health.…”

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confidence: 99%

“…[20][21][22][23][24][25] Finally, interventions, such as tailored coaching, that customize support to a patient's current level of activation have also been successful in increasing activation, improving health indicators, and reducing costly hospital and emergency department use. 24,25 Studies to date suggest that even when patients have multiple chronic illnesses, are socioeconomically disadvantaged, or are elderly, they can still make gains in activation and exert some measure of control over their day-to-day health. 18,21,[24][25][26] Perhaps the most encouraging finding from intervention studies is that with targeted interventions, patients who are the least activated appear to realize the greatest gains in activation.…”

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confidence: 99%

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Patients With Lower Activation Associated With Higher Costs; Delivery Systems Should Know Their Patients’ ‘Scores’

2013

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Patient activation is a term that describes the skills and confidence that equip patients to become actively engaged in their health care. Health care delivery systems are turning to patient activation as yet another tool to help them and their patients improve outcomes and influence costs. In this article we examine the relationship between patient activation levels and billed care costs. In an analysis of 33,163 patients of Fairview Health Services, a large health care delivery system in Minnesota, we found that patients with the lowest activation levels had predicted average costs that were 8 percent higher in the base year and 21 percent higher in the first half of the next year than the costs of patients with the highest activation levels, both significant differences. What's more, patient activation was a significant predictor of cost even after adjustment for a commonly used "risk score" specifically designed to predict future costs. As health care delivery systems move toward assuming greater accountability for costs and outcomes for defined patient populations, knowing patients' ability and willingness to manage their health will be a relevant piece of information integral to health care providers' ability to improve outcomes and lower costs.

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Patients With Lower Activation Associated With Higher Costs; Delivery Systems Should Know Their Patients’ ‘Scores’

2013

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“…Sustained effects of the TPE interventions on quality of life or depressive symptoms were not observed after the interventions ended. 79,86 The lack of a sustained effect on these outcomes suggests that additional strategies are needed to maintain the positive effect on psychological status over time. Significant enhancement in functional status and performance was observed when cardiac rehabilitation classes and community-based exercise sessions were used, 64 whereas nonsignificant changes in physical and emotional function were found in cases in which the TPE focused on topics of self-management (ie, diet modification, medication use).…”

Section: Hf Outcomesmentioning

confidence: 99%

Evidence for Therapeutic Patient Education Interventions to Promote Cardiovascular Patient Self-Management: A Scientific Statement for Healthcare Professionals From the American Heart Association

Barnason¹,

White‐Williams²,

Rossi³

et al. 2017

Circ: Cardiovascular Quality and Outcomes

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A lthough the overall rate of death associated with cardiovascular disease (CVD) continues to decline in the United States, [1][2][3] CVD is a leading cause of mortality and disability. The burden of CVD remains high, underscoring the need to improve long-term management of CVD as a chronic illness. Effective implementation of current treatment guidelines for primary and secondary prevention of CVD relies heavily on patient knowledge and engagement in carrying out the plan of care. Healthcare reforms have increasingly shifted the responsibility for self-management to patients and families as hospital stays and ambulatory visits have become shorter and less frequent.Background-The burden of cardiovascular disease as a chronic illness increasingly requires patients to assume more responsibility for their self-management. Patient education is believed to be an essential component of cardiovascular care; however, there is limited evidence about specific therapeutic patient education approaches used and the impact on patient self-management outcomes. Methods and Results-An integrative review of the literature was conducted to critically analyze published research studies of therapeutic patient education for self-management in selected cardiovascular conditions. There was variability in methodological approaches across settings and disease conditions. The most effective interventions were tailored to individual patient needs, used multiple components to improve self-management outcomes, and often used multidisciplinary approaches. Conclusions-This synthesis of evidence expands the base of knowledge related to the development of patient selfmanagement skills and provides direction for more rigorous research. Recommendations are provided to guide the implementation of therapeutic patient education in clinical practice and the design of comprehensive self-management interventions to improve outcomes for cardiovascular patients. (Circ Cardiovasc Qual Outcomes. 2017;10:e000025.

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“…Interventions such as coaching tailored to a patient's level of activation can increase activation levels, improve health indicators and reduce costs. 74,75 At the population level, whole communities, comprising both current and future patients, could be engaged by way of citizen juries in discussions around what constitutes value-added, preference-sensitive care choices for common clinical scenarios. 76 …”

Section: Actively Involve Patients In Shared Decision Making and Selfmentioning

confidence: 99%

Ten clinician-driven strategies for maximising value of Australian health care

Scott¹

2014

Aust. Health Review

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Objective. To articulate the concept of high-value care (i.e. clinically relevant, patient-important benefit at lowest possible cost) and suggest strategies by which clinicians can promote such care in rendering the Australian healthcare system more affordable and sustainable.Methods. Strategies were developed by the author based on personal experience in clinical practice, evidence-based medicine and quality improvement. Relevant literature was reviewed in retrieving studies supporting each strategy.Results. Ten strategies were developed: (1) minimise errors in diagnosis; (2) discontinue low-or no-value practices that provide little benefit or cause harm; (3) defer the use of unproven interventions; (4) select care options according to comparative cost-effectiveness; (5) target clinical interventions to those who derive greatest benefit; (6) adopt a more conservative approach nearing the end of life; (7) actively involve patients in shared decision making and self-management; (8) minimise day-to-day operational waste; (9) convert healthcare institutions into rapidly learning organisations; and (10) advocate for integrated patient care across all clinical settings.Conclusions. Clinicians and their professional organisations, in partnership with managers, can implement strategies capable of maximising value and sustainability of health care in Australia.What is known about this topic? Value-based care has emerged as a unitary concept that integrates quality and cost, and is being increasingly used to inform healthcare policy making and reform. What does this paper add? There is scant literature that translates the concept of high value care into actionable enhancement strategies for clinicians in everyday practice settings. This article provides 10 strategies with supporting studies in an attempt to fill this gap. What are the implications for practitioners? If all practitioners, in partnership with healthcare managers, attempted to enact all 10 strategies in their workplaces, a significant quantum of healthcare resources could be redirected from low-to highvalue care, culminating in much greater health benefit from the healthcare dollars currently being spent. However, such reforms will require a shift in clinician thinking and practice away from volume-based care to value-based care.

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Effect of Patient Activation on Self-Management in Patients With Heart Failure

Abstract: This study supports the importance of targeted interventions to improve patient activation or engagement in HF care. Further work is needed related to HF self-management measurement and outcomes.

Cited by 177 publications

References 21 publications

Patients With Lower Activation Associated With Higher Costs; Delivery Systems Should Know Their Patients’ ‘Scores’

Patients With Lower Activation Associated With Higher Costs; Delivery Systems Should Know Their Patients’ ‘Scores’

Evidence for Therapeutic Patient Education Interventions to Promote Cardiovascular Patient Self-Management: A Scientific Statement for Healthcare Professionals From the American Heart Association

Ten clinician-driven strategies for maximising value of Australian health care

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