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How Race Affects Patient Activation Impact on Hospital Readmission

High patient activation decreases the likelihood for hospital readmissions by 18 percent. In white patients, activation decreases the chances of hospital readmission by 33 percent.

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Source: Thinkstock

By Sara Heath

- High patient health literacy leads to better patient activation and reduces the likelihood of preventable hospital readmissions, according to a group of researchers from Boston University. However, racial disparities exist, emphasizing a need to cater patient education to specific demographics.

The team looked at a 570-patient sample at Boston Medical Center, which serves a significant safety-net population. By examining patient activation measure (PAM) scores and patient health literacy assessments, the research team identified a positive correlation between the two and low rates of 30-day hospital readmissions.

A PAM score that was one standard deviation above the average resulted in an 18 percent odds reduction for avoidable hospital readmission, for example.

When adjusting for racial demographics, the effects are less pronounced. Fifty-four percent of the sample population was black and another 13 percent were Hispanic, the researchers found. Primarily the 33 percent of white patients enjoyed the benefits of better health literacy on their hospital readmission rates.

A PAM score that was one standard deviation above the average resulted in a 33 percent odds reduction for hospital readmissions for white patients, the researchers found. While the researchers maintained that more research is necessary to better understand this phenomenon, they did offer some hypotheses.

The PAM may have an implicit bias toward white patients, potentially impacting the BU researchers’ data, the team said. The PAM was developed with an 88 percent white patient population, which many industry experts say predispositions the measure in favor of white patients.

Evidence shows that the PAM is also biased toward English-speaking patients, the researchers said, citing past studies. Although the BU study only included English-speaking patients, the team did not collect any data about cultural differences that could also explain patient activation disparities.

Thus, healthcare professionals must do more to specifically cater their patient education and health literacy improvement efforts to individual racial demographics. Using strategies that target specific demographics will increase the odds that health literacy improves and the patient becomes more activated, ideally reducing the number of 30-day hospital readmissions.

The team was also hindered by unclear parameters for “avoidable” hospital readmissions. The team did exclude planned readmissions, such as follow-up readmissions, but otherwise did not have adequate information for which readmissions truly could have been avoided. This is a prevalent issue throughout the healthcare industry, which many experts are working to overcome.

“Safety net hospitals serve patients with a high burden of comorbidities, have higher readmission rates, and, therefore, are more likely to receive payment cuts from Medicare,” the researchers pointed out. “Therefore, it is important for future studies as well as hospital systems to assess if rehospitalizations are avoidable given the financial implications.”

Reducing the number of avoidable 30-day hospital readmissions is critical for healthcare organizations because readmissions are extremely costly. Unexpected medical intervention can run up a large bill for both patients and providers. Additionally, certain value-based payment models issue large reimbursement penalties for organizations that exceed a certain readmission threshold.

Safety net hospitals are particularly vulnerable to these financial penalties because they serve a higher proportion of low-income and ethnic minority populations considered high-risk for readmission,” the researchers said. “These financial penalties may also exacerbate existing racial and socioeconomic health disparities.”

It is therefore critical for safety net hospitals to drive efforts to improve patient health literacy and patient activation. Supplementing a patient’s knowledge, skills, and confidence in self-managing her health will likely improve the PAM. An improved PAM will ideally result in fewer hospital readmissions, promoting overall patient health and larger value-based reimbursements.

Healthcare organizations looking to improve patient activation scores to reduce hospital readmissions should support not only their white patient populations, but all racial demographics. To do so, hospital leaders will need more information on cultural health differences to shape their specific interventions.

“These findings have implications on identifying targets for interventions to reduce hospital readmissions at institutions serving ethnic minority populations,” the research team concluded. “Understanding the mechanism of patient activation across and within diverse populations is important given the provisions under the Patient Protection and Affordable Care Act (2010) to engage patients in managing their health care.”

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