Charlot Marjory, Winter Michael R, Cabral Howard, Wolf Michael S, Curtis Laura M, Hanchate Amresh, Paasche-Orlow Michael
Department of Medicine Boston University School of Medicine, Boston, MA, USA.
Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA.
Health Lit Res Pract. 2017 Jul;1(3):e128-e135. doi: 10.3928/24748307-20170621-01. Epub 2017 Sep 6.
Reducing the 30-day hospital readmission rate is a national priority and patient activation has emerged as a modifiable target to reduce hospital readmissions.
Prior studies demonstrate that low patient activation and low health literacy are each associated with higher rates of hospital utilization. The aim of this study was to use path analysis methods to assess if patient activation mediates the relationship between health literacy and hospital utilization in the 30 days after discharge.
We performed a secondary analysis of data from a randomized controlled trial of patients receiving care at an urban safety net hospital. Path analyses were used to assess patient activation as a mediator of the relationship of education and health literacy with 30-day hospital utilization. The final model was stratified by race and ethnicity.
30 day Hospital Utilization.
In the overall study sample, a one standard deviation (SD) higher patient activation measure (PAM) score was associated with 18% reduced odds of hospital utilization (odds ratio (OR) 0.82, 95% confidence interval (CI): 0.73, 0.91, p=<0.001). PAM mediated the relationship between education level and health literacy and hospital utilization. When stratified by race, the mediating effect of PAM was evident among Whites, but not among non-Whites. Specifically, a one SD higher PAM score was significantly associated with a 33% reduced odds of utilization among Whites (OR 0.67, 95% CI: 0.57, 0.79, p<0.001). With the inclusion of PAM in the model, there was no direct relationship between either health literacy or education and 30-day hospital utilization.
Patient activation is only associated with hospital utilization among Whites. Further research is needed to assess if this selective protection is seen in other cohorts. Potential interventions to reduce hospital readmissions may need to consider other modifiable factors in racially and ethnically diverse populations.
降低30天再入院率是一项国家重点任务，而患者激活已成为降低医院再入院率的一个可调节目标。
先前的研究表明，患者激活水平低和健康素养低均与较高的医院利用率相关。本研究的目的是使用路径分析方法来评估患者激活是否介导出院后30天内健康素养与医院利用率之间的关系。
我们对在一家城市安全网医院接受治疗的患者的随机对照试验数据进行了二次分析。路径分析用于评估患者激活作为教育与健康素养和30天医院利用率之间关系的中介变量。最终模型按种族和民族进行分层。
30天医院利用率。
在整个研究样本中，患者激活测量（PAM）得分每高出一个标准差（SD），医院利用率的几率就降低18%（优势比（OR）0.82，95%置信区间（CI）：0.73，0.91，p<0.001）。PAM介导了教育水平、健康素养与医院利用率之间的关系。按种族分层时，PAM的中介作用在白人中明显，但在非白人中不明显。具体而言，PAM得分每高出一个标准差，白人的利用率几率显著降低33%（OR 0.67，95%CI：0.57，0.79，p<0.001）。在模型中纳入PAM后，健康素养或教育与30天医院利用率之间均无直接关系。
患者激活仅与白人的医院利用率相关。需要进一步研究以评估在其他队列中是否也存在这种选择性保护。降低医院再入院率的潜在干预措施可能需要考虑种族和民族多样化人群中的其他可调节因素。
