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Patient Activation Status as a Predictor of Patient Experience Among Medicare Beneficiaries

Heller, Amy PhD*‡; Elliott, Marc N. PhD; Haviland, Amelia M. PhD; Klein, David J. PhD; Kanouse, David E. PhD

doi: 10.1097/MLR.0b013e318197b661
Original Article

Background: Patient activation status (PAS) can be identified using the Medicare Segmentation Screening Tool, a 2-item measure assessing patients’ health skills and motivation to participate in their own care.

Objective: To determine whether PAS is predictive of Medicare beneficiary health care experiences with health providers and insurance plans after case-mix adjustment.

Research Design: Linear regression models examined the association between PAS and evaluations of care after case-mix adjustment in observational cross-sectional data.

Subjects: 236,322 Medicare beneficiaries with at least one prescription medication responding to the Medicare Segmentation Screening Tool items on the 2007 Medicare Consumer Assessment of Healthcare Providers and Systems Survey.

Measures: Four-category patient activation category; 11 patient-reported evaluations of health care and providers and 2 self-reported immunization measures.

Results: PAS was strongly predictive of beneficiary experience beyond case-mix adjustment. Even after case-mix adjustment, active beneficiaries consistently reported the most positive experiences, followed by complacent beneficiaries, with differences of 0.2 to 0.4 standard deviations for 4 of 5 composite measures of patient experience (P < 0.05). Adjusted immunization rates for flu and pneumonia were highest for active beneficiaries, followed closely by high-effort beneficiaries. The rates for these 2 segments were 10 percentage points higher than for complacent and passive beneficiaries.

Conclusions: PAS may be an important determinant of health care experiences. More confident respondents (active and complacent) give higher ratings of their care and providers, suggesting that they have more favorable experiences. Respondent motivation (high for active and high effort) seems to be a factor in receiving preventive care.

From the *Publishing Division, Department of Quality Products and Registries, American College of Cardiology, Washington, District of Columbia; †RAND Corporation, Santa Monica, California; and ‡Healthy Policy Consulting, Washington, District of Columbia.

Supported by CMS contract HHSM-500-2005-000281.

The contents of the publication are solely the responsibility of the authors and do not necessarily reflect the official views of CMS.

Reprints: Marc N. Elliott, PhD, RAND Corporation, 1776 Main St, PO Box 2138, Santa Monica, CA 90407-2138. E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.