title: Adding A Measure Of Patient Self-Management Capability To Risk Assessment Can Improve Prediction Of High Costs.
abstract: We explored whether supplementing a clinical risk score with a behavioral measure could improve targeting of the patients most in need of supports that reduce their risk of costly service utilization. Using data from a large health system that determines patient self-management capability using the Patient Activation Measure, we examined utilization of hospital and emergency department care by the 15 percent of patients with the highest clinical risk scores. After controlling for risk scores and placing patients within segments based on their level of activation in 2011, we found that the lower the activation level, the higher the utilization and cost of hospital services in each of the following three years. These findings demonstrate that adding a measure of patient self-management capability to a risk assessment can improve prediction of high care costs and inform actions to better meet patient needs.
authors.affiliation: Judith H. Hibbard (jhibbard@uoregon.edu) is a professor emerita at and senior researcher in the Health Policy Research Group of the University of Oregon, in Eugene.
authors.forename: Judith H
authors.initials: JH
authors.lastname: Hibbard
authors.affiliation: Jessica Greene is a professor in and associate dean of the School of Nursing at the George Washington University, in Washington, D.C.
authors.forename: Jessica
authors.initials: J
authors.lastname: Greene
authors.affiliation: Rebecca Sacks is a data analyst in the School of Nursing at the George Washington University.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Sacks
authors.affiliation: Valerie Overton is vice president for quality and innovation at the Fairview Medical Group, in Minneapolis, Minnesota.
authors.forename: Valerie
authors.initials: V
authors.lastname: Overton
authors.affiliation: Carmen D. Parrotta is a performance improvement consultant at the Fairview Medical Group.
authors.forename: Carmen D
authors.initials: CD
authors.lastname: Parrotta
mesh_terms: D060866:Accountable Care Organizations / Q000191:economics; D000328:Adult; D000368:Aged; D017046:Cost Savings; D004636:Emergency Service, Hospital / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D015438:Health Behavior; D017048:Health Care Costs; D006302:Health Services Research; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012648:Self Care / Q000191:economics* / Q000706:statistics & numerical data; D014481:United States
keywords: Chronic Care; Consumer Issues; Cost of Health Care