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© 2008 University of Oregon Engaging Consumers to Improve Health and Reduce Costs Judith Hibbard, DrPH Professor University of Oregon
© 2008 University of Oregon 2 Engaged Consumer What does it mean to be activated or engaged? Have knowledge, skill, confidence to manage health and health care In any population group, some people will be at the low, middle, and high end of this dimension.
© 2008 University of Oregon 3 Activation is developmental Source: J.Hibbard, University of Oregon
© 2008 University of Oregon 4 Activation Level is Predictive of Behaviors Research consistently finds that those who are more activated are: – Engaged in more preventive behaviors – Engaged in more healthy behaviors – Engaged in more disease specific self- management behaviors – Engaged in more health information seeking behaviors
© 2008 University of Oregon 5 Activation Level Linked with Most Behaviors Source: US National sample 2004
© 2008 University of Oregon 6 Implications Many of the behaviors we are asking of people are only done by those in highest level of activation Persistence in asking – when dont understand--in medical encounter Effectively use high deductible health plans Knowing about treatment guidelines Using quality information/ knowing where to find it When we focus on the more complex and difficult behaviors– we may discourage the least activated Start with behaviors more feasible for consumers to take on, increases individuals opportunity to experience success. Help consumers by breaking behaviors down into smaller steps
© 2008 University of Oregon 7 Low activation signals problems (and opportunities) 7
© 2008 University of Oregon 8 Multivariate analysis which controlled for age group, gender, race, comorbidities and number of diabetes-related prescriptions. Carol Remmers. The Relationship Between the Patient Activation Measure, Future Health Outcomes, and Health Care Utilization Among Patients with Diabetes. Kaiser Care Management Institute, PhD Dissertation. The Activation can predict utilization and health outcomes two years into the future for diabetics % change for a 1 point change in PAM Score Comparing a PAM Score of 70 (L4) vs. 50 (L2) P Hospitalization 1.7% decline34% decreased likelihood of hospitalization.03 Good A1c control (HgA1c < 8%) 1.8% gain40% greater likelihood of good glycemic control.01 A1c testing 3.4% gain 68% greater likelihood of testing.01 LDL-c testing
© 2008 University of Oregon 9 What specific Interventions Have Been Shown to Increase Activation? Stanford CDSMP (peer support and problem solving) Worksite programs– Environmental Tailored coaching Clinician support
© 2008 University of Oregon 10 Tailored Coaching Study Intervention group coached based on level of activation. Control group was usual care coaching (DM company) Examined changes in claims data, clinical indicators, and activation levels 6 month Intervention period.
© 2008 University of Oregon 11 The intervention group demonstrated significant reductions in utilization Tailored coaching Usual coaching
© 2008 University of Oregon 12 Supporting Activation Means supporting people where they are Moving away from a generalized approach to a tailored or segmented approach. Doing so will likely increase the efficiency and efficacy of efforts.
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