Nathaniel A Erskine1, Barbara Gandek, Molly E Waring, Rebecca L Kinney, Darleen M Lessard, Randolph S Devereaux, Stavroula A Chrysanthopoulou, Catarina I Kiefe, Robert J Goldberg. 1. Nathaniel A. Erskine, BA Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester. Barbara Gandek, PhD Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester; and John Ware Research Group, Watertown, Massachusetts. Molly E. Waring, PhD Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester. Rebecca L. Kinney, MPH Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester. Darleen M. Lessard, MS Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester. Randolph S. Devereaux, PhD, MSPH College of Medicine, Mercer University, and Department of Community Medicine, Mercer University School of Medicine, Macon, Georgia. Stavroula A. Chrysanthopoulou, PhD Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester. Catarina I. Kiefe, MD, PhD Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester. Robert J. Goldberg, PhD Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester.
Abstract
BACKGROUND: Patient activation comprises the knowledge, skills, and confidence for self-care and may lead to better health outcomes. OBJECTIVES: We examined the relationship between patient activation and changes in health-related quality of life (HRQOL) after hospitalization for an acute coronary syndrome (ACS). METHODS: We studied patients from 6 medical centers in central Massachusetts and Georgia who had been hospitalized for an ACS between 2011 and 2013. At 1 month after hospital discharge, the patients completed the 6-item Patient Activation Measure and were categorized into 4 levels of activation. Multinomial logistic regression analyses compared activation level with clinically meaningful changes (≥3.0 points, generic; ≥10.0 points, disease-specific) in generic physical (SF-36v2 Physical Component Summary [PCS]), generic mental (SF-36v2 Mental Component Summary [MCS]), and disease-specific (Seattle Angina Questionnaire [SAQ]) HRQOL from 1 to 3 and 1 to 6 months after hospitalization, adjusting for potential sociodemographic and clinical confounders. RESULTS: The patients (N = 1042) were, on average, 62 years old, 34% female, and 87% non-Hispanic white. A total of 10% were in the lowest level of activation. The patients with the lowest activation had 1.95 times (95% confidence interval, 1.05-3.62) and 2.18 times (95% confidence interval, 1.17-4.05) the odds of experiencing clinically significant declines in MCS and SAQ HRQOL, respectively, between 1 and 6 months than the most activated patients. The patient activation level was not associated with meaningful changes in PCS scores. CONCLUSIONS: Hospital survivors of an ACS with lower activation may be more likely to experience declines in mental and disease-specific HRQOL than more-activated patients, identifying a group at risk of poor outcomes.
BACKGROUND:Patient activation comprises the knowledge, skills, and confidence for self-care and may lead to better health outcomes. OBJECTIVES: We examined the relationship between patient activation and changes in health-related quality of life (HRQOL) after hospitalization for an acute coronary syndrome (ACS). METHODS: We studied patients from 6 medical centers in central Massachusetts and Georgia who had been hospitalized for an ACS between 2011 and 2013. At 1 month after hospital discharge, the patients completed the 6-item Patient Activation Measure and were categorized into 4 levels of activation. Multinomial logistic regression analyses compared activation level with clinically meaningful changes (≥3.0 points, generic; ≥10.0 points, disease-specific) in generic physical (SF-36v2 Physical Component Summary [PCS]), generic mental (SF-36v2 Mental Component Summary [MCS]), and disease-specific (Seattle Angina Questionnaire [SAQ]) HRQOL from 1 to 3 and 1 to 6 months after hospitalization, adjusting for potential sociodemographic and clinical confounders. RESULTS: The patients (N = 1042) were, on average, 62 years old, 34% female, and 87% non-Hispanic white. A total of 10% were in the lowest level of activation. The patients with the lowest activation had 1.95 times (95% confidence interval, 1.05-3.62) and 2.18 times (95% confidence interval, 1.17-4.05) the odds of experiencing clinically significant declines in MCS and SAQ HRQOL, respectively, between 1 and 6 months than the most activated patients. The patient activation level was not associated with meaningful changes in PCS scores. CONCLUSIONS: Hospital survivors of an ACS with lower activation may be more likely to experience declines in mental and disease-specific HRQOL than more-activated patients, identifying a group at risk of poor outcomes.
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