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Clinical Preventive Service Utilization among Medicare Beneficiaries: An Examination of the Role of Patient Activation Open Access

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This research explores the role patient activation, a health behavior construct, plays on clinical preventive service (CPS) utilization among Medicare Fee-For-Service (FFS) beneficiaries. The United States’ population is aging. Less than half of older Americans in the United States (US) receive the recommended CPS as outlined in the Healthy People 2020 Objectives. Such underutilization contributes to negative health outcomes, specifically morbidity and mortality resulting from one or more chronic conditions. Finding successful interventions and levers to improve the utilization of CPS for Medicare beneficiaries is critical. This research conducted a secondary data analysis using the Medicare Current Beneficiary Survey of a sample of community dwelling Medicare FFS beneficiaries during 2011-2013. Principal Component Analysis was conducted on the Patient Activation Supplement to assess its strength as an alternative to the standard Patient Activation Measure developed by Hibbard et al. Univariate, bivariate, and multivariate analyses were then conducted to assess patient activation’s impact on CPS utilization in the sample population over a three-year period. Principal Component Analysis of the MCBS Patient Activation Supplement resulted in a 12-item scale that demonstrated moderate performance, α=0.73. The sample consisted of 10,559 Medicare beneficiaries which equates to 39.95 million Medicare FFS beneficiaries in 2011. Utilization across the six CPSs were low, irrespective of patient activation level. Across all three years, less than 20% of beneficiaries received an Annual Wellness Visit, mammography screening hovered around 40%, colorectal screening remained around 10%, and utilization for depression screening and the alcohol abuse screening barely reaching 1%. Flu vaccines were the most widely used CPS with utilization around 50% across all three years. Bivariate analysis demonstrated statistically significant impacts at the P=0.05 level of a dichotomous patient activation level variable which slightly dissipated when a three-level categorical variable was introduced. Mammography screening was the only CPS for which patient activation had a statistically significant effect across 2011, 2012, and 2013. Every increase in level of patient activation was associated with 39% (OR=1.396, p=0.001), 22% (OR=1.396, p=0.001), and 47% (OR=1.223, p=0.002) greater odds of receiving mammography screening compared to beneficiaries with low activation and controlling for all other variables. Baseline utilization of a CPS, use in 2011, had strong and highly significant effects on utilization in 2012 and 2013 across all CPSs analyzed. Findings demonstrate the need for additional research to further strengthen the MCBS Patient Activation Supplement. This research has implications for how Medicare targets education and marking toward beneficiaries with low activation and could be a useful strategy to try in improve the initial uptake. Medicare can also engage in additional activities to target the dually eligible population which has negative findings across all services. This research adds to the literature through examination of the patient activation supplement within the Medicare population analyzing actual CPS utilization from the administrative claims data versus self-reports. It also allowed for a longitudinal look at utilization over a three years period vs a point in time cross sectional analysis.

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