Reducing 30-day readmission rates has become an important mission to helping improve quality of care and containing healthcare costs. Previous studies have suggested that patients who have the know­ledge, skills, and confidence to manage their own care after hospital discharge—a concept dubbed patient activation—can result in better health outcomes and lower rates of health service utilization. “It’s possible that greater patient activation can help decrease rates of 30-day hospital readmissions among those with chronic illnesses,” says Suzanne E. Mitchell, MD, MS.

An In-Depth Analysis

In a study published in the Journal of General Internal Medicine, Dr. Mitchell and colleagues sought to determine the role of patient activation in the rate of hospital readmissions within 30 days of hospital discharge. The study team used an abbreviated version of the Patient Activation Measure (PAM), an assessment that was developed to measure how actively patients are involved in their healthcare. Based on PAM responses, participants were assigned a PAM level between 1 and 4, with level 1 being the least engaged and level 4 being the most engaged. The total 30-day post-discharge hospital utilization was defined as total ED visits plus hospital readmissions, including observation stays.


According to the study results, 30-day post-discharge hospital utilization was higher for those with lower levels of activation (PAM level 1) when compared with highly activated patients (PAM level 4). The rate ratio for PAM level 1 patients was also higher when compared with PAM level 4 patients for ED use alone and for hospital readmissions alone. “We observed a dose-effect between patient activation and readmissions in that the rate of readmissions decreased with increasing levels of activation,” adds Dr. Mitchell. “This implies that any improvement in patient activation level would reduce the risk for 30-day readmission significantly.” Those with low activation had nearly twice the rate of readmissions as patients with the highest levels of engagement.

Assessing the Implications

“It’s challenging to determine patients’ ability to self-manage after they leave the hospital,” adds Dr. Mitchell. “We need to find interventions that effectively improve patient activation so that they become engaged, motivated, and active participants in their care. Patient activation is modifiable, but interventions must be tailored based on each person’s characteristics. This information should then be used when developing care plans.”

Dr. Mitchell says that screening for patient activation may be a helpful strategy to reducing hospital readmission rates in the future, but more research is needed. “Each patient has varied access to care as well as socioeconomic and educational differences to consider,” she says. “The key is to find out if patient activation can be identified as a real risk factor and treated as such to enhance how patients are managed.”


Mitchell SE, Gardiner PM, Sadikova E, et al. Patient activation and 30-day post-discharge hospital utilization. J Gen Intern Med. 2013 Oct 4 [Epub ahead of print]. Available at:

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Mitchell SE, Sadikova E, Jack BW, Paasche-Orlow MK. Health literacy and 30-day post-discharge hospital utilization. J Health Commun. 2012;17(Suppl):325-338.

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