title: Association between patient activation and patient-assessed quality of care in type 2 diabetes: results of a longitudinal study.
abstract: BACKGROUND
  Previous research using cross-sectional data has shown a positive relationship between patient activation and quality of care. The quantitative relationships in the same patients over time, however, remain undefined.
  
  
  OBJECTIVE
  To examine the relationship between changes in activation over time and patient-assessed quality of chronic illness care.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  The study used data reported annually from 2008 (N = 3761) to 2010 (N = 3040), using self-report survey questionnaires, completed by patients with type 2 diabetes in a population-based cohort in Queensland, Australia.
  
  
  METHODS
  Principal measures were the 13-item Patient Activation Measure (PAM), and the 20-item Patient Assessment of Chronic Illness Care (PACIC) instrument.
  
  
  METHODS
  Nonparametric anova was used to determine the association between patient activation and patient-assessed quality of care in low and high patient activation groups at baseline (2008), and in 2009 and 2010, when patients had changed group membership. The Wilcoxon signed ranks test was used to compare the PACIC scores between baseline and each follow-up survey for the same patient activation level.
  
  
  RESULTS
  Patient activation was positively associated with the median PACIC score within each survey year and within each of the groups defined at baseline (high- and low-activation groups; P < 0.001).
  
  
  CONCLUSIONS
  Patient activation and the PACIC change in the same direction and should be considered together in the interpretation of patient care assessment. This can be carried out by interpreting PACIC scores within strata of PAM.
authors.affiliation: School of Population Health, University of Queensland, Brisbane, Qld, Australia.
authors.forename: Eindra
authors.initials: E
authors.lastname: Aung
authors.affiliation: School of Medicine, University of Queensland, Brisbane, Qld, Australia.
authors.forename: Maria
authors.initials: M
authors.lastname: Donald
authors.affiliation: School of Population Health, University of Queensland, Brisbane, Qld, Australia.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Coll
authors.affiliation: School of Population Health, University of Queensland, Brisbane, Qld, Australia.
authors.forename: Gail M
authors.initials: GM
authors.lastname: Williams
authors.affiliation: School of Population Health, University of Queensland, Brisbane, Qld, Australia.
authors.forename: Suhail A R
authors.initials: SA
authors.lastname: Doi
mesh_terms: D000368:Aged; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005260:Female; D006801:Humans; D008134:Long-Term Care; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D017060:Patient Satisfaction; D011787:Quality of Health Care / Q000592:standards*; D011793:Queensland; D012648:Self Care / Q000592:standards*; D011795:Surveys and Questionnaires
keywords: Patient Assessment of Chronic Illness Care; chronic illness care; patient activation; patient experiences; quality assessment