Authors: Jessica Greene, Judith H. Hibbard, Rebecca Sacks, and Valerie Overton
Journal: Health Affairs, July 2013 32(7):1295–1305
Patients who have the knowledge, skills, and confidence to manage their health and health care report better health care experiences than patients with lower levels of “activation” who see the same clinicians. Findings from this Commonwealth Fund–supported study suggest that care experiences are transactional―shaped by providers and patients alike.
Patients’ ratings of their care experiences, an important part of quality improvement efforts, are now increasingly being linked to payment, with providers receiving higher compensation when their patients report better experiences. Although a number of patient characteristics can influence these assessments, many—like age, race, income, education, language—are for the most part unchangeable and can be adjusted for in patient experience ratings. One characteristic linked to care experiences that can be changed is patient activation: patients’ understanding of their role in the care process, and their knowledge, skill, and confidence in managing their health and health care. Researchers examined patient data from an integrated health system in Minnesota to answer the following questions: Do more-activated patients report better care experiences than less-activated patients? Are more-activated patients more likely to go to primary care providers who are more patient-centric? And, do more-activated patients report better care experiences than less-activated patients when seeing the same provider?
◾When seeing the same physician, patients at higher levels of activation had more positive experiences than patients at lower levels—those at the highest level of activation (level 4) rated their primary care providers 10 percent to 14 percent higher than did patients at the lowest level (level 1).
◾The difference in patient care experience was not driven by more-activated patients seeking out more patient-centric primary care providers. Rather, highly activated patients reported better care experiences than less-activated patients when seeing the same primary care provider.
Addressing the Problem
“The evidence suggests that what is happening is not that patients who are more activated are selecting more patient-centric primary care providers or that some providers have increased their patients’ activation scores,” the authors write. Instead, the results, they say, suggest that patients who are more activated are better able to obtain satisfying care experiences with any primary care provider. While it is likely that highly activated patients are proactive in getting the care they need, providers may also respond differently to more- or less-activated patients. Patients who are less activated may be more passive with their providers, who may respond by being less collaborative.
These findings suggest that care experiences are transactional, shaped by providers as well as patients. Improving patients’ experiences, therefore, should focus not just on providers but on helping patients to elicit what they need from their providers.
About the Study
The researchers used patient activation data, which they were able to link back to primary care providers, from Fairview Health Services, an integrated health system in Minnesota. In addition, Fairview surveyed a sample of its patients in 2010 about their care experiences with their providers. A total of 5,002 patients who saw 49 providers were included in the analysis.
The Bottom Line
Even when seeing the same clinician, highly activated patients—those who have the knowledge, skills, and confidence to manage their health and health care—had more positive health care experiences than less-activated patients. Successful strategies for improving patient experience will likely be ones that help patients get what they need from their health care providers.