GS5 - Identifying Factors Associated with Patient Activation Among Patients Undergoing Colorectal Surgery

Purpose/Background: Patient activation is a key component of patient-centered care. It is determined by a patient’s knowledge, skills, motivation, and confidence to participate in one’s own health care. Studies have shown that higher patient activation is associated with better surgical outcomes and reduced healthcare costs. However, patient activation among colorectal surgery patients remains largely unexplored. Therefore, the aim of this study was to determine factors associated with patient activation among patients undergoing colorectal surgery.

Methods/Interventions: A retrospective cohort study utilizing single-institution ACS-NSQIP data from July 2021 to June 2023 was conducted for patients undergoing elective and emergent colorectal surgery. Patient activation was measured using the 10-item Patient Activation Measure (PAM-10) survey by Insignia Health. Similar to prior studies, PAM scores were divided into four levels and then dichotomized into low PAM (levels 1 and 2) and high PAM (levels 3 and 4) groups. The primary outcome was patient activation. Bivariate analysis was conducted using Pearson chi-square tests for categorical data and Kruskal-Wallis Rank Sum tests for continuous data. Multivariable logistic regression was performed for the adjusted model analysis. All statistical tests were performed at an alpha level of 0.05 using SAS 9.4 (Cary, NC).

Results/Outcomes: A total of 329 patients were included in the study with 177 patients in the low PAM group. Overall, the median age was 58.8 years and BMI was 27.8 kg/m2. Most patients were White (n=227, 69.0%), female (n=171, 52.0%), had an ASA score of 3 (n=265, 80.5%), and were undergoing laparoscopic (n=128, 38.9%) or open (n=132, 40.1%) surgical approach, with partial colectomy (n= 143, 43.5%) being the most common surgical procedure. There were no significant differences in patient-level factors including age (p=0.65), BMI (p=0.67), sex (p=0.38), race (p=0.14), smoking status (p=0.29), and diabetes status (p=0.24) between the two PAM groups. Compared to the high PAM group, the low PAM group had a lower proportion of patients who had undergone laparoscopic (40.9 vs. 41.7%, p< 0.001) or robotic (4.7 vs. 23.0%, p< 0.001) colorectal surgery. Patients in the low PAM group more often had an ASA score of 4 (11.3 vs. 2.0%, p=0.01) and had undergone open surgery (48.5 vs. 35.3%, p< 0.001) and extended colectomies (25.5 vs. 22.4%, p=0.04) in comparison with the high PAM group. After multivariable analysis, patients with ASA 2 score had higher odds (odds ratio [OR]: 8.3, 95%CI 1.4-51.3, p=0.03) of having higher PAM scores in comparison with patients with ASA 4 score. Further, patients undergoing laparoscopic surgery had lower odds (OR: 0.23, 95%CI 0.09-0.59, p=0.02) of having higher patient activation versus robotic surgery. After adjusting for all other factors, patients with high health literacy levels had three times higher odds (OR: 3.05, 95% CI 1.65-5.65, p=0.0004) of having higher patient activation in comparison with patients with low health literacy.

Conclusion/Discussion: Health literacy, ASA score, and operative approaches are associated with patient activation. Efforts to improve patient activation will need to account for each of these factors. Health literacy is particularly actionable and thus may represent a unique target for patient activation.