Study gauges effect of patient engagement on health costs

Researchers say there’s early evidence that patients actively involved in care can mean more spending — and, perhaps, greater health disparities.

By — Posted June 11, 2013

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At least in the hospital setting, a more engaged patient is also a more expensive patient, say researchers from the University of Chicago.

Patients who expressed a preference to participate in their medical decision-making stayed, on a per-person basis, a quarter of a day longer in the hospital, resulting in $865 in additional costs, compared with patients who preferred to delegate all decisions to their physicians, according to a study posted online May 27 by JAMA Internal Medicine, formerly Archives of Internal Medicine (link).

Researchers said that, based on the 28.9% of patients in the study who wanted to be fully engaged in their care, those figures could translate nationwide to an additional 2.6 million hospital days and $8.7 billion in costs annually.

The researchers looked at nearly 22,000 patients in the University of Chicago Medical Center’s general internal medicine practice between 2003 and 2011, matching their survey answers on patient engagement with their hospitalization rates. The hospitalized patients stayed an average of 5.3 days.

It is probable that many engaged patients, especially if their care is covered by insurance, might be less aware of costs when they choose a course of treatment, the University of Chicago researchers wrote. “This contrasts with the expectation that patient participation in care decisions might decrease costs and suggests that it is important to increase patient engagement in decision-making with respect to their effects on outcomes and costs,” they wrote.

However, researchers aren’t ready to say their results will translate to all settings. Given the “absence of published qualitative evidence of effects on patient involvement in medical decision-making on costs,” the researchers cautioned that more study is needed to see if, for example, results might be different in a wholly primary care setting.

They also did not measure patient outcomes to see if that additional hospital time was necessary, or reduced costs in the long term.

Engagement and care disparities

Along with cost effects, researchers said, their study could be used as a jumping-off point to look at which patients are most likely to be engaged in their care and how that could affect health disparities. The nonelderly, whites, women, the college-educated and the privately insured all were most likely to want to be engaged in their care.

Blacks, who made up 76% of the studied population; those who hadn’t completed high school; and patients insured by public plans or who carry no coverage showed rates below the overall 28.9% figure in patient engagement.

The disparities in engagement, researchers wrote, could come as physicians become “more responsive to medical decision preferences” among “more empowered groups, who are already more likely to receive medical care.”

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