Correlation of Patient Activation Measure Level with Patient Characteristics and Type of Vascular Disease.
Correlation of Patient Activation Measure Level with Patient Characteristics and Type of Vascular Disease.
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DOI：
10.1016/j.avsg.2020.11.019
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发表时间：
2021-05
影响因子：
1.5
通讯作者：
Mell MW
中科院分区：
文献类型：
--
作者：
Humphries MD;Welch P;Hasegawa J;Mell MW
患者的积极性或参与医疗护理的程度与许多疾病的再入院和更差的结果有关。激活水平较高的患者通常会指导他们的护理，而不是充当护理的被动观察者。本研究旨在确定患者人口统计数据或血管疾病类型是否可以预测患者的激活。所有在 4 个月内到血管门诊就诊的患者均被要求完成患者激活测量 (PAM) 调查。总共收集了 257 份已完成的调查。调查回复按照带有锚点的李克特量表进行评分。回答按 1-100 分进行统计，并根据先前验证的评分系统转换为 1-4 级汇总级别。 1 级患者被认为缺乏参与和不知所措。 2 级患者开始意识到自己的医疗保健，但仍然在挣扎。 3 级患者正在采取行动，而 4 级代表患者正在保持健康行为并进一步努力。然后进行卡方检验和多变量回归以确定患者特征或疾病类型是否与激活水平相关。总共有 257 名患者完成了调查。参与者的平均年龄为 67 岁 (±15)。 16% 的患者独居，58% 的患者已婚，39% 的患者平均家庭收入低于 50,000 美元。总体而言，21 名患者 (8.2%) 被分类为 1 级、65 名 (25%) 2 级、94 名 (37%) 3 级和 77 名 (30%) 4 级。该组包括 32% 的 PAD、20% 的颈动脉、18% 的主动脉/动脉瘤、14% 的静脉和 16% 的各种其他血管疾病。每个疾病组都存在广泛的激活，但血管疾病类型和激活水平之间没有显着差异。慢性肢体威胁性缺血 (CLTI) 患者占 PAD 组的 35% (n = 29)，其中 66% 的患者报告激活水平为 3 (n = 10) 或 4 (n = 9)。与一般 PAD 队列相比，CLTI 患者报告的激活水平没有差异 (P = 0.99)。多变量分析表明，年龄、受教育程度、家庭收入和血管疾病类型与 PAM 评分相关，但症状持续时间或种族和性别之间不存在相关性。根据患者特征或血管疾病类型，患者的激活是不可预测的，并且 CLTI 患者报告了高激活水平。仅收集患者人口统计数据的高质量数据库可能无法完全捕获患者不良结果的预测因素。应在血管患者中进一步探索 PAM 调查的使用，将激活水平与血管特异性结果相关联。
Patient activation or level of engagement in one’s medical care is linked to hospital readmissions and worse outcomes in a number of diseases. Patients with higher levels of activation are typically guiding their care rather than acting as passive observers of care. This study aims to determine if either patient demographics or type of vascular disease can predict patient activation. All patients presenting over a 4-month period to an outpatient vascular clinic were asked to complete the Patient Activation Measure (PAM) survey. In total, 257 completed surveys were collected. Survey responses were scored on a Likert scale with anchors. Responses are tallied with a score of 1–100 and converted to summary levels 1–4 in accordance with the previously validated scoring system. Level 1 patients are considered disengaged and overwhelmed. Patients in level 2 are becoming aware of their health care, but still struggle. Level 3 patients are taking action, while level 4 represents patients who are maintaining healthy behaviors and pushing further. Chi-squared test and multivariable regression were then performed to determine if patient characteristics or type of disease correlated with activation levels. In total, 257 patients completed the survey. The mean participant age was 67 years (±15). Sixteen percent of patients lived alone, 58% were married, and in 39% mean household income was <$50,000. Overall, 21 patients (8.2%) were classified as level 1, 65 (25%) level 2, 94 (37%) level 3, and 77 (30%) level 4. The group comprised 32% PAD, 20% carotid, 18% aortic/aneurysm, 14% venous, and 16% were various other vascular diseases. Over each disease group there was a wide range of activation, but no significant difference between the type of vascular disease and activation level. Chronic limb-threatening ischemia (CLTI) patients comprised 35% (n = 29) of the PAD group, and 66% of these patients reported an activation level of 3 (n = 10) or 4 (n = 9). There was no difference in the levels of activation reported by the CLTI patients compared to the general PAD cohort (P = 0.99). Multivariable analysis demonstrated that age, level of education, household income, and type of vascular disease correlated with PAM score, but there was no correlation between length of symptoms or race and gender. Patient activation is unpredictable using patient characteristics or type of vascular disease, and CLTI patients report high activation levels. Quality databases that collect only patient demographics may not fully capture patient predictors of poor outcomes. Use of the PAM survey should be further explored in vascular patients to correlate activation level with vascular-specific outcomes.
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