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- Title
Association Between Patient Activation and Health Care Utilization After Thoracic and Abdominal Surgery.
- Authors
Dumitra, Teodora; Ganescu, Olivia; Hu, Richard; Fiore, Julio F.; Kaneva, Pepa; Mayo, Nancy; Lee, Lawrence; Liberman, A. Sender; Chaudhury, Prosanto; Ferri, Lorenzo; Feldman, Liane S.; Fiore, Julio F Jr
- Abstract
<bold>Importance: </bold>Increased patient activation (PA) (ie, knowledge, skills, motivation, confidence to participate in care) may result in improved outcomes, especially in surgical settings.<bold>Objective: </bold>To estimate the extent to which PA is associated with 30-day postdischarge unplanned health care utilization after major thoracic or abdominal surgery.<bold>Design, Setting, and Participants: </bold>This cohort study was performed at 2 centers of a tertiary care hospital network between October 2017 and January 2019. Adult patients undergoing thoracic or abdominal surgery were included. Of 880 patients assessed for eligibility, 692 were deemed eligible, of whom 34 declined to participate, 1 withdrew consent, and 4 were excluded after consent.<bold>Exposures: </bold>Patient activation was measured immediately after surgery during the initial admission using the Patient Activation Measure (score range, 0-100). Patients were dichotomized into low and high PA groups using previously described thresholds (Patient Activation Measure score, ≤55.1).<bold>Main Outcomes and Measures: </bold>The primary outcome was unplanned 30-day postdischarge health care utilization (composite including emergency department and outpatient clinic visits and/or hospital readmission). Secondary outcomes were length of stay, 30-day emergency department visits, 30-day readmissions, and postoperative complications.<bold>Results: </bold>A total of 653 patients admitted for thoracic, general, colorectal, and gynecologic surgery were included in the study (mean [SD] age, 58 [15] years; 369 women [56%]; 366 [56%] had minimally invasive surgery; 52 [8%] had emergency surgery), of which 152 (23%) had a low level of PA. Baseline characteristics were similar between patients with low- and high-level PA. Low PA was associated with unplanned health care utilization (odds ratio [OR], 3.15; 95% CI, 2.05-4.86; P < .001), emergency department visits (OR, 1.64; 95% CI, 1.02-2.64; P = .04), complications (OR, 1.63; 95% CI, 1.11-2.41; P = .01), and length of stay (adjusted mean difference, 1.19 days; 95% CI, 0.06-2.33; P = .04). Low PA was not associated with a higher risk of readmission (adjusted OR, 1.04; 95% CI, 0.56-1.93; P = .90).<bold>Conclusions and Relevance: </bold>In this study, low level of PA was associated with postdischarge unplanned health care use, hospital stay, and complications after major surgery. Identification of patients with low activation may allow the implementation of interventions to improve health care knowledge and support self-management postdischarge.
- Subjects
LENGTH of stay in hospitals; RESEARCH; OUTPATIENT medical care; HOSPITAL emergency services; PATIENT participation; THORACIC surgery; TIME; RESEARCH methodology; PATIENT readmissions; SURGICAL complications; EVALUATION research; COMPARATIVE studies; HEALTH attitudes; LONGITUDINAL method
- Publication
JAMA Surgery, 2021, Vol 156, Issue 1, pe205002
- ISSN
2168-6254
- Publication type
journal article
- DOI
10.1001/jamasurg.2020.5002