Does patient activation matter? An examination of the relationships between patient activation and healthcare use in older adults with mild frailty after discharge from an emergency department
Kristie Harper
A B C * , Melinda Williamson A , Glenn Arendts D , Deborah Edwards A , Bridgette Buller A , Jenna Haak A , Angela Jacques A E , Annette Barton A , Antonio Petta A and Antonio Celenza A D
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Abstract
Patient engagement, as measured by the Patient Activation Measure (PAM®), has been used to assess patients’ ability to manage their own care. This study aimed to determine whether the PAM® could predict healthcare use in older adults aged >70 years, living independently in the community with mild frailty, within 30 days after emergency department (ED) discharge.
A prospective single-centre observational cohort study was completed including older adults who presented to an ED. The 13-item PAM® and selected International Consortium for Health Outcomes Measures were completed prior to ED discharge.
Two hundred patients were recruited with a mean age of 84.8 years (s.d. 6.9). The mean PAM® score was 58.6 (s.d. 13.3), with 12.5% at Level 1 (n = 25), 40% at Level 2 (n = 80), 34.5% at Level 3 (n = 69) and 13.0% at Level 4 (n = 26). The PAM® level was significantly associated with ED presentations in the past 6 months (P = 0.030). The PAM® level did not predict healthcare use within 30 days of discharge consisting of time until ED representation (P = 0.557), number of ED representations (P = 0.560), number of hospital admissions (P = 0.499), length of stay in hospital (P = 0.254) and number of post-discharge contacts (P = 0.667).
Overall, the PAM® did not predict prospective short-term healthcare use. However, the PAM® was significantly associated with 6-month previous ED use. With more than 50% of patients at Level 1 or 2, indicating lower capacity for self-management, tailored interventions are required to assist mildly frail patients to manage discharge care plans and engage in preventative strategies.
Keywords: aftercare, aged, emergency department, frailty, hospitals, patient activation, patient discharge, self-management.
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