Racial/ethnic and socioeconomic diversity in patient activation research: A systematic literature review
Abstract
BACKGROUND: In the US, 5% of patients incur over 50% of health care costs[1]. These “super utilizer” patients typically have multiple chronic conditions and require frequent hospitalizations. Complex Care Management (CCM)... [ view full abstract ]
BACKGROUND: In the US, 5% of patients incur over 50% of health care costs[1]. These “super utilizer” patients typically have multiple chronic conditions and require frequent hospitalizations. Complex Care Management (CCM) programs address rising health care costs by serving “super utilizer” patients. CCMs use the Patient Activation Measure (PAM), the most commonly used measure to assess patient knowledge and confidence for self-management[2], to track patient progress. Urban safety-net CCMs serve low-income, racially/ethnically diverse patients diagnosed with multiple chronic conditions often concurrent with substance use or mental health diagnoses. Providers need to track clinical progress for care planning and to document success. A systematic literature review was conducted to assess the inclusion of safety-net populations in patient activation research.
METHODS: A systematic search of PubMed and Web of Science was conducted for articles conducted in the US and published between 2004 and 2015 that used the PAM.
RESULTS: 56 articles were identified. For the studies that did report race/ethnicity (88%), the samples were 3-100% non-White. For SES, 64% and 31% of the studies did not report any information on income or education about their sample, respectively. 41 studies had samples with at least 33% non-White or people with low income or low education. Of those, 10 studies reported differences in PAM scores by race/ethnicity, education, or income among racially/ethnically or socioeconomically diverse samples; the mean PAM score was 66, corresponding to the upper bounds of Stage 3 which indicates engagement in recommended health behaviors. Only 5 out of the 10 studies were longitudinal studies, none of which investigated CCM-specific program interventions.
CONCLUSIONS: Current literature suggests that PAM may not be able to assess progress in the urban CCM safety-net setting, with vulnerable patients who start at very low levels of activation and have compromised living circumstances.
Authors
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Tessa Napoles
(University of California San Francisco)
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Nancy Burke
(University of California San Francisco)
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Janet Shim
(University of California San Francisco)
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Elizabeth Davis
(University of California San Francisco)
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David Moskowitz
(Alameda Health System)
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Irene Yen
(University of California San Francisco)
Topic Areas
V. Healthcare Service 5.1 Accessibility of healthcare services and its optimization 5.2 He , I. Urbanization AND Health: what interactions? 1.1 New paradigms, concepts, methods, and t
Session
PS-1 » POSTER SESSION 1 (12:10 - Friday, 1st April, TBA)
Paper
ISUH_abstract_2016_01_18_v6_clean.doc
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