Patient Activation Status as a Predictor of Patient Experience Among Medicare Beneficiaries
Patient Activation Status as a Predictor of Patient Experience Among Medicare Beneficiaries
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DOI：
10.1097/mlr.0b013e318197b661
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发表时间：
2009-08-01
期刊：
影响因子：
3
通讯作者：
Kanouse, David E.
中科院分区：
文献类型：
--
作者：
Heller, Amy;Elliott, Marc N.;Kanouse, David E.
背景：患者激活状态(PAS)可以使用Medicare细分筛选工具来确定，该工具由两个项目组成，用于评估患者的健康技能和参与其自身护理的动机。目的：确定PAS在病例组合调整后是否可以预测与医疗保健提供者和保险计划的医疗保健体验有关的PAS。研究设计：在观察性横断面数据中，线性回归模型检验了PAS和护理评估之间的关联。研究对象：236,322名至少有一种处方药对2007年Medicare消费者医疗保健提供者评估和系统调查有效的Medicare受益人。测量：四类患者激活类别--11项患者报告的对卫生保健和提供者的评估以及2项自我报告的免疫措施。结果：PAS对病例组合调整以外的受益者经历具有很强的预测性。即使在病例组合调整后，积极的受益者始终报告最积极的经历，其次是自满的受益者，5项患者体验综合测量中的4项标准差为0.2至0.4标准差(P<；0.05)。流感和肺炎的调整免疫接种率在积极受益者中最高，紧随其后的是努力程度较高的受益者。这两个部分的比例比自满和被动受益者高10个百分点。结论：PAS可能是卫生保健经历的一个重要决定因素。更自信的受访者(积极和自满)对他们的护理和提供者给出了更高的评级，这表明他们有更有利的经历。应答者的动机(积极和努力程度高)似乎是接受预防保健的一个因素。
Background: Patient activation status (PAS) can be identified using the Medicare Segmentation Screening Tool, a 2-item measure assessing patients' health skills and motivation to participate in their own care.Objective: To determine whether PAS is predictive of Medicare beneficiary health care experiences with health providers and insurance plans after case-mix adjustment.Research Design: Linear regression models examined the association between PAS and evaluations of care after case-mix adjustment in observational cross-sectional data.Subjects: 236,322 Medicare beneficiaries with at least one prescription medication responding to the Medicare Segmentation Screening Tool items on the 2007 Medicare Consumer Assessment of Healthcare Providers and Systems Survey.Measures: Four-category patient activation category-, 11 patient-reported evaluations of health care and providers and 2 self-reported immunization measures.Results: PAS was strongly predictive of beneficiary experience beyond case-mix adjustment. Even after case-mix adjustment, active beneficiaries consistently reported the most positive experiences followed by complacent beneficiaries, with differences of 0.2 to 0.4 standard deviations for 4 of 5 composite measures of patient experience (P < 0.05). Adjusted immunization rates for flu and pneumonia were highest for active beneficiaries, followed closely by high-effort beneficiaries. The rates for these 2 segments were 10 percentage points higher than for complacent and passive beneficiaries.Conclusions: PAS may be an important determinant of health care experiences. More confident respondents (active and complacent) give higher ratings of their care and providers, Suggesting that they have more favorable experiences. Respondent motivation (high for active and high effort) seems to be a factor in receiving preventive care.