Skip to main content

Reduce Readmissions by Activating Patients to Do 'Self-Care'

By Tinker Ready  
   April 10, 2014

The push is on to target patients who need help with self-care, which is key to lowering hospital readmission rates. A tool to measure "patient activation" offers healthcare providers a way to look beyond the bedside to assist patients.

Editor's note: Cheryl Clark is on vacation.

Some patients follow doctors' orders. Some don't.

For years, hospitals and health systems have been trying to find ways to improve patient compliance when it comes to follow-up care. But, terms like "orders" and "compliance" feel outdated in the age of patient engagement. These days, many patients object to being ordered around and insist on working with doctors and transition teams on a personalized recovery plan.

Others are happy to accept a care plan; they just have trouble following through. Now, researchers and providers are finding new ways to look beyond the bedside to assist patients most likely to skip meds or develop post-op infections.

The goal is to improve the quality of care while reducing costly readmissions. So, the push is on to target patients who need help with the self-care, which is key to a full recovery.

Some hospitals are taking the big data route, mining electronic health records for clues to the type of patient most likely to be readmitted. But, if the key is to encourage self-care, the answer may be as low-tech as a survey. New research suggests that a tool to measure "patient activation" offers a way to reduce readmissions.

While patient engagement describes the act of participating in decisions about your own care, activation describes a patient's willingness and capacity to do so.

While she didn't coin the term, Judith Hibbard, PhD, of the University of Oregon has developed and tested a way to measure patient activation. An emeritus professor at the school's Institute for Policy Research, she has spent 10 years collecting data on the efficacy of a 13-question survey called the Patient Activation Measure.

The survey gauges whether a patient has the drive and skills needed to stick to a follow-up plan. It asks patients whether they feel responsible for managing their own health. It also asks whether they know how to prevent complications. Their answers to these and 11 other questions slot patients into one of four activation categories: "Low activated" patients are unlikely or unwilling to play an active role in their care, while "high activated" patients are most likely be fully involved.

Search PubMed on Hibbard's name and you get hit after hit of research validating how well the PAM predicts a patient's level of engagement. Now, she and others are generating data on the impact of PAM on readmissions. Hibbard has licensed the test to a company called Insignia Health, which sells it with the slogan "Measure. Engage. Activate."

Patients take the test while in the hospital and their score helps the discharge team tailor follow-up instructions and care. "For high-activated patients, they may follow up with a phone call," Hibbard said. "For low-activated patients, they may go to the home."

A study of 695 patients published in February looked at the relationship between PAM scores and 30-day readmission rates at Boston University Medical Center. The result: Patients rated "low" on the activation scale were twice as likely to be readmitted within 30 days as those who earned high PAM scores.

Small Data Leads to Larger Efforts
While the answers to all 13 questions probably qualify as small data, some hospitals are using it as a starting point from which larger self-care initiatives are being launched. At HealthIT.gov, the website of the Office of the National Coordinator, a featured "success story" describes such a program at the Mountain States Health Alliance in Johnson City, TN. 

The EHR system there monitors records for cues, such as symptoms of blood infection, and then contacts providers. The story notes that once the system flags a case that is likely to result in a readmission, providers and hospital staff can take steps such as 'reminding patients about preventive care, prescribing medicine, or deploying case managers to help patients navigate treatment plans." Hospitals nationwide are trying some version of this approach.

At the Mayo Clinic's cardiac surgery program, doctors are putting tools to improve self-care right into patients' hands in the form of iPads. David J. Cook, MD, is an anesthesiologist and intensivist at Mayo. He says it was very clear to his team that patients need to be involved in their own care in a meaningful way to ensure a smooth recovery.

"The only way we can get patient to participate in their recovery is to make them well informed," he said.

But he describes traditional patient education programs as "unwieldy or ineffective," and cites as an example the 285-page booklet and two DVDs Mayo patients traditionally get before cardiac surgery. Under Cook's program, surgery patients get a slim computer tablet loaded with a personalized care plan. It includes clinical milestones, educational videos and a "to do" list.

For example, he says, the care plan will tell a patient that a bladder catheter is going to come out the day after surgery "So if it gets to be late in the day and it hasn't happened, the patient or spouse or family members can say, 'Our expectation was the bladder catheter was coming out. Why hasn't it come out?' These kinds of conversations are critical, Cook says.

Another nice touch: Patients get a FitBit bracelet that electronically tracks their movements. So, if someone is up and walking, or not, care staff will know.

At the moment, the iPad and the data it holds can't leave the hospital—HIPPA and security concerns won't allow it. And it's specific to cardiac surgery only.

But the low-tech PAM survey looks beyond the hospital doors and is not specific to any diagnosis. Both have their benefits and together they represent a growing recognition that self-care plays an important role in quality of care.

Pages

Tagged Under:


Get the latest on healthcare leadership in your inbox.