Reistroffer Cindy, Hearld Larry R, Szychowski Jeff M
Priority Health, 1231 E Beltline Ave NE, Grand Rapids, MI 49525. E-mail:
Am J Manag Care. 2017 Feb;23(2):123-128.
A growing body of research has established the benefits of patient activation, which is defined as the knowledge, skills, confidence, and motivation to make effective decisions and take action to maintain or improve one's health. Consequently, healthcare stakeholders of all types continue to seek ways to improve patient activation. The purpose of this study was to empirically examine whether enrollment in a health plan-sponsored care management (CM) program that included coaching for activation (CFA) was associated with utilization, medication adherence, and clinical outcomes.
Cross-sectional, quantitative study of commercially insured enrollees in a Midwest-based health plan.
Poisson, logistic, and ordinary least squares regression models were used to test the relationships between CM programs and outcomes.
The benefit of measuring patient activation and offering CFA was associated with reduced healthcare utilization and better clinical outcomes. Relative to respondents in the CFA CM group (ie, intervention), respondents in the usual CM group experienced 18.29% more emergency department visits, 97.78% more hospital admissions, a higher glycated hemoglobin level (β = 0.48; P <.001), and higher systolic blood pressure (β = 1.19; P <.01).
These findings suggest that coaching interventions based on activation level may help care managers engage in more effective interactions that strengthen a patient's role in managing his or her healthcare. Programs that are more targeted in their application, rather than uniformly developed and implemented, may be an important factor in reducing utilization and improving clinical outcomes.
越来越多的研究证实了患者激活的益处，患者激活被定义为做出有效决策并采取行动以维持或改善自身健康的知识、技能、信心和动力。因此，各类医疗保健利益相关者不断寻求提高患者激活水平的方法。本研究的目的是实证检验参加一项由健康计划赞助的护理管理（CM）项目（该项目包括激活辅导（CFA））是否与医疗服务利用、药物依从性和临床结果相关。
对一家位于美国中西部的健康计划的商业保险参保者进行横断面定量研究。
使用泊松回归、逻辑回归和普通最小二乘法回归模型来检验CM项目与结果之间的关系。
测量患者激活水平并提供CFA的益处与减少医疗服务利用和改善临床结果相关。相对于CFA CM组（即干预组）的受访者，常规CM组的受访者急诊就诊次数多18.29%，住院次数多97.78%，糖化血红蛋白水平更高（β = 0.48；P <.001），收缩压更高（β = 1.19；P <.01）。
这些发现表明，基于激活水平的辅导干预可能有助于护理管理者进行更有效的互动，从而加强患者在管理其医疗保健方面的作用。在应用中更具针对性而非统一制定和实施的项目，可能是降低医疗服务利用并改善临床结果的一个重要因素。
