An Examination of the Relationship Between Care Management With Coaching for Activation and Patient Outcomes

作者：Reistroffer Cindy^*; Hearld Larry R; Szychowski Jeff M

来源：American Journal of Managed Care, 2017, 23(2): 123-128.

OBJECTIVES: A growing body of research has established the benefits of patient activation, which is defined as the knowledge, skills, confidence, and motivation to make effective decisions and take action to maintain or improve one's health. Consequently, healthcare stakeholders of all types continue to seek ways to improve patient activation. The purpose of this study was to empirically examine whether enrollment in a health plan-sponsored care management (CM) program that included coaching for activation (CFA) was associated with utilization, medication adherence, and clinical outcomes.
STUDY DESIGN: Cross-sectional, quantitative study of commercially insured enrollees in a Midwest-based health plan.
METHODS: Poisson, logistic, and ordinary least squares regression models were used to test the relationships between CM programs and outcomes.
RESULTS: The benefit of measuring patient activation and offering CFA was associated with reduced healthcare utilization and better clinical outcomes. Relative to respondents in the CFA CM group (ie, intervention), respondents in the usual CM group experienced 18.29% more emergency department visits, 97.78% more hospital admissions, a higher glycated hemoglobin level (beta = 0.48; P < .001), and higher systolic blood pressure (beta = 1.19; P < .01).
CONCLUSIONS: These findings suggest that coaching interventions based on activation level may help care managers engage in more effective interactions that strengthen a patient's role in managing his or her healthcare. Programs that are more targeted in their application, rather than uniformly developed and implemented, may be an important factor in reducing utilization and improving clinical outcomes.

• 出版日期2017-2