Impact of medical care coordination intervention on patient activation.

Abstract

Objective: To evaluate the impact of an adult medical care coordination (AMCC) intervention on patient activation.

Study design: This observational evaluation compared AMCC with usual care (UC). Eligible patients were adults discharged home who had 2 or more chronic conditions and a high risk of readmission. AMCC involved registered nurse care coordinators providing self-management support to patients via 1 home visit and regular phone calls. The outcome was the 10-item Patient Activation Measure (PAM), a validated patient-reported outcome tool with 4 levels ranging from 1 (lower activation) to 4 (higher activation). Measurement occurred at baseline and 30, 90, and 180 days.

Methods: We evaluated patient activation as an ordinal outcome using an ordered logistic regression model, a dichotomous outcome using a linear probability model, and a continuous outcome using ordinary least squares.

Results: We identified 915 (432 AMCC, 483 UC) patients who completed both the baseline and at least 1 follow-up PAM. For the ordinal analysis, AMCC was associated with a significant increase in the percentage with a PAM of level 3 at 30, 90, and 180 days and a decrease in the percentage with a PAM of level 1 or 2 at 180 days. For the dichotomous analysis, AMCC was associated with a significant increase in the percentage of patients with a PAM of level 3 or 4 at 180 days (15.2 percentage points; 95% CI, 5.6-24.7).

Conclusions: AMCC significantly increased patient activation, particularly at the final measurement. These findings highlight the potential value of AMCC as a self-management intervention, enhancing patients' confidence to manage their health.