T. C. Dumitra1, N. Mayo1,2, P. Kaneva1, J. Mata1, J. F. Fiore1, A. S. Liberman1,3, P. Charlebois1,3, B. Stein1,3, L. Lee1,3, G. M. Fried1, L. S. Feldman1 2McGill University,Department Of Epidemiology,Montreal, QC, Canada 3McGill University,Colorectal Surgery,Montreal, QC, Canada 1McGill University,General Surgery,Montreal, QC, Canada
Introduction:
Patient activation is defined as a patient’s knowledge, skills, beliefs and confidence to manage their own health care. In patients with chronic medical conditions, there is a strong association between high levels of activation and improved healthcare outcomes, higher patient satisfaction, lower resource utilization and lower costs. However, there is very little evidence on the role of patient activation in surgical patients. The goal of this study was to estimate the extent to which low preoperative activation predicts emergency department (ED) visits and postoperative outcomes after colorectal surgery.
Methods:
A secondary analysis of data obtained from a randomized trial completed in 2017 at the McGill University Health Center was performed. Adult patients who underwent scheduled colorectal surgery were included. Patient activation was measured using the Patient Activation Measure (PAM) at baseline and before hospital discharge, and classified as high or low. Primary outcome was 30-day ED visits. Secondary outcomes included enhanced recovery pathway adherence, complications and patient satisfaction. Characteristics were compared between patients with high and low activation using Chi-square, Fisher’s exact test, t-test or ANOVA when appropriate. Multiple logistic regression determined the independent effect of low baseline activation on ED visits, adjusted for age, gender, comorbidity index, diagnosis and complications.
Results:
A total of 97 patients were included in the study cohort, of which 14% (n=14) had a low baseline level of activation. Patient characteristics were similar between the two activation groups. Patients in the high activation group had higher adherence to postoperative care processes on postoperative day 1 (66% vs 47%, p=0.004), and felt more informed and more motivated (p<0.005) in their care. More patients with high activation had a length of stay < 3 days compared to low activation patients (37% vs 7%, p=0.021). There was no difference in the incidence of postoperative complications (47% in high vs 43% in low activation). A higher number of patients had low levels of activation at hospital discharge compared to preop (30% vs 14% p=0.009). There was no difference in the percentage of patients with at least one ED visits between the two groups (21% in high vs 20% in low group, p=0.548). On multiple regression, only 30-day postoperative complications predicted ED visits (OR 19.4, 95%CI 3.8-98.1).
Conclusion:
This pilot study suggests that levels of activation do not predict ED use after discharge in patients undergoing colorectal surgery. However, highly activated patients have a higher adherence to care pathways, tend to be discharged sooner after surgery, and feel more informed and more motivated in their care. Patient activation levels decreased in the immediate postoperative period. Further studies in a larger cohort of surgical patients is warranted.