All ETDs from UAB

Advisory Committee Chair

Larry R Hearld

Advisory Committee Members

S Robert Hernandez

Jeff M Szychowski

Timothy C Zeddies

Document Type

Dissertation

Date of Award

2015

Degree Name by School

Executive Doctor of Science (DSc) School of Health Professions

Abstract

As part of healthcare reform, patient engagement is becoming an important area of focus. Most recently, patient activation, as part of engagement, has been studied; however, interventions to improve activation are not well identified. The purpose of this dissertation was to empirically examine whether enrollment in care management with patient activation (PA)-customized coaching was associated with patient outcomes of utilization, medication adherence, and clinical outcomes. The study utilized the chronic care model framework and theoretical insights from social cognitive theory to examine the relationships among three hypotheses. Secondary data related to commercially-insured enrollees in Priority Health were used to test hypothesized relationships using Poisson and regression models. The findings suggest that combining patient activation with PA-customized coaching (i.e., intervention) was significantly associated with patient outcomes. Among this particular population, patient activation, by itself, had a rather limited impact on clinical outcomes with the exception of HbA1c. In other words, patient activation was significantly associated with clinical outcome HbA1c, in which lower activated enrollees tended to have higher HbA1c levels relative to higher activated enrollees. The real benefit of measuring patient activation was the ability to offer PA-customized coaching to enrollees, which was associated with better utilization and clinical outcomes. Relative to respondents in the PA-customized coaching group, respondents in the non-PA-customized coaching group (usual care) experienced 18.3% more ED visits, 97.8% more hospital admissions, and a significant association to clinical outcomes of HbA1c and systolic blood pressure. These results offer important insights related to care management and caregivers’ ability to influence potentially avoidable ED visits and hospital admissions while influencing patients to become better self-mangers of their health. The findings of the study are useful to providers, provider organizations, healthcare administrators, payers, and policymakers to advance their knowledge in patient engagement specifically regarding the impact of patient activation and the intervention of PA-customized coaching, and collectively in terms of their relationship to healthcare. These findings suggest that patient activation when coupled with an intervention such as customized coaching is an important factor in patient engagement. It also provides important insights to be explored in future research.

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