Background: Hospital discharge is a vulnerable time: patients are at risk for readmission, adverse events, and death. Activated patients–those with the knowledge, confidence, and skills to engage in activities that promote self-management–are more likely to execute a safe discharge plan and less likely to be readmitted. Educational videos focused on self-management may increase patient activation at discharge, but this has not been shown. This study aimed to determine the acceptability of providing patients with condition-specific educational videos at discharge and to explore potential associations with patient activation.
Methods: This sub-study was conducted on general medical units at a large academic medical center in Boston, MA. Patients were eligible if they were enrolled in the Patient-centered Discharge Toolkit study and had a primary discharge diagnosis for which an educational video was available (Box 1) based on electronic health record review by a physician. Enrollees were invited to view an educational video specific to the discharge diagnosis on a mobile device. All patients approached were asked to complete the PAM-13 survey (13-Item Patient Activation Measure, Insignia Health) prior to discharge and during a 30-day follow-up call. We compared mean PAM-13 scores at, and 30 days after discharge, as well as 30-day readmission rates between patients who agreed and declined to view the video.
Results: Of 115 patients screened, 36 (31.3%) were eligible and approached based on their main discharge diagnosis (Figure 1). Of these 36 patients (Figure 1), 18 (50.0%) consented to view the video. In general, demographics (Table 1) were similar, although viewers were younger than non-viewers (56.2 vs 68.9 yrs of age, p=0.02), and typically male (72.2% vs 38.9%, p=0.04). Regarding outcomes, viewers (Table 2) had significantly higher mean PAM scores compared to non-viewers (75.5 vs 60.2, p=0.05). Thirty-day readmissions were lower among viewers compared to non-viewers (5.6% vs 11.1%, p=0.55).
Conclusions: In this non-randomized study, younger and male patients were more amenable to condition-specific video education, and viewers were more highly activated than non-viewers. This suggests that patients who were willing to view condition-specific videos were either intrinsically more activated or activated by viewing the educational video. Among both groups, mean PAM-13 scores were higher at discharge and trended lower at 30 days post-discharge. While there was a trend toward lower rates of readmission among participants compared to non-participants, this did not reach statistical significance. Going forward, it would be instructive to randomly assign patients to discharge interventions targeted at increasing patient activation and measure PAM-13 scores before and after such interventions to determine whether PAM-13 scores are better used as a predictive variable or as an outcome measure.