Abstract
Background/Aims The patient activation measure (PAM) refers to an individual’s skills, knowledge, and confidence to manage their health and their ability to engage health providers in shared decision making practices. Such skills are important for the ongoing management of chronic conditions, such as hypertension. Although research has examined the association of PAM with utilization and health outcomes; little research has examined the association of PAM with medical costs. The objective of this research was to examine the prospective association of PAM with four cost measures: 1) total costs, 2) emergency department (ED) costs, 3) inpatient costs and 4) pharmacy costs.
Methods Using an observational study design, we studied 1,812 patients with hypertension with a PAM assessment between 12/4/2007 and 2/28/201. The PAM is 13 items and categorizes PAM into four levels: PAM 1(lowest level of activation, where patients typically lack confidence and self-management skills and may not understand the need to be actively involved in managing their health) and PAM 4 (highest activation where patients typically have the necessary self-management skills and are more pro-active about their health). Patients received care in Kaiser Permanente Northwest (KPNW) and were enrolled in care management programs. Per patient per month (PPPM) medical costs were calculated 12 months after the PAM assessment date. Costs were constructed in 4 areas: total, ED, inpatient and pharmacy. Using Ordinary Least Squares Regression, each cost measure was regressed on PAM level (PAM 1 [reference group] vs. PAM 2, PAM 3, and PAM 4); adjusting for the following covariate measures; demographics and a severity of illness. We performed statistical analyses on logged PPPM medical costs, but report comparisons in absolute dollars (2011).
Results Compared to those with PAM 1 scores, those with PAM 3 scores had lower total costs (beta coefficient = − $849; P = .0004), ED costs (beta coefficient = − $22; P = .02) and inpatient costs (beta coefficient = − $500; P = .03).
Conclusions Among a population with hypertension; adults with higher PAM scores (PAM 3) had significantly lower total costs, ED costs and inpatient costs, compared to patients with lower PAM scores (PAM 1).
