Patients with the knowledge, skills and confidence to be actively engaged in their health care are likely to incur lower health care costs than patients without those characteristics, according to a recent study in Health Affairs.
 
An accompanying literature review by two of the same authors found a growing body of evidence that more actively engaged patients (or “activated” patients) also have better health outcomes and health care experiences.
 
In the cost study (2013;32:216-222), the researchers examined data from 33,163 primary care patients enrolled with Fairview Health Services, a hospital system based in Minneapolis, Minn. Patient activation was measured with a scoring system consisting of 13 items such as “I know how to prevent problems with my health” and “I am confident that I can tell a doctor my concerns, even when he or she does not ask.” The researchers found that patient activation scores from 2010 were a significant predictor of cost of care in the first half of 2011: Patients with the lowest activation level had costs 21% higher than patients with the highest activation level (P<0.05). The findings held true even after controlling for sociodemographic factors and the severity of health conditions.
 
“The study highlights the important role that patients play in determining outcomes,” lead author Judith H. Hibbard, PhD, MPH, professor emerita in the Department of Planning, Public Policy, and Management at the University of Oregon, Eugene, said in a statement. “We found that patients who were more knowledgeable, skilled and confident about managing their day-to-day [treatment] … had health care costs that were substantially lower than patients who lacked this type of confidence and skill.”
 
The literature review (2013;32:207-214), by Dr. Hibbard and Jessica Greene, PhD, MPH, the director of research at the George Washington University School of Nursing, in Washington, D.C., identified several interventions that have been shown to increase patient activation, such as tailored coaching—a strategy that helps customize support to the individual’s activation level. Efforts to expand patient activation are, the authors concluded, “a pathway toward improving outcomes.”