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Abstract: PO1185

Patient Activation in Prevalent Hemodialysis Patients in the United States

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Hussein, Wael F., Satellite Healthcare, San Jose, California, United States
  • Bennett, Paul N., Satellite Healthcare, San Jose, California, United States
  • Sun, Sumi J., Satellite Healthcare, San Jose, California, United States
  • Reiterman, Marc, Satellite Healthcare, San Jose, California, United States
  • Watson, Emily, Satellite Healthcare, San Jose, California, United States
  • Farwell, DSW, Ian Michael James, Satellite Healthcare, San Jose, California, United States
  • Schiller, Brigitte, Satellite Healthcare, San Jose, California, United States

Patient activation (PA) is the product of knowledge, skills and confidence that enable a person to manage their health and care. PA is associated with healthy behaviors, disease management and hospitalization rates. This study aimed to investigate the status and correlates of PA among prevalent HD patients in the US.


We surveyed patients from 10 HD centers using the Patient Activation Measure 13-item instrument (PAM-13), which reports a score out of 100 and is categorized into four levels (higher scores or levels denoting higher activation). We described the distribution of PA status, and investigated associations with demographics, vintage, education level and HD center.


925 respondents completed the survey out of 1374 patients (response rate 67%). Mean age 62 ± 14 years, 40% female, and median vintage 41 months (IQR 19-77). Mean PAM score was 56 ± 13, and 14%, 50%, 25%, and 10% were in levels 1 to 4 respectively. Mean PAM scores were higher in younger patients (<55yrs: 59 ± 14, 55 to <65yrs: 55 ± 14, 65 to < 75: 55 ±12, >75 yrs:54 ± 12; p<0.001). Higher PAM scores were observed with higher education (College: 60 ± 14, High School: 57 ± 14, <High School: 51 ± 10; p<0.001) and in blacks (58 ± 15) compared to non-blacks (55 ± 13; p=0.008). Mean PAM scores varied significantly across centers ranging between 52 and 61 (p=0.004).

In regression analysis, there were lower odds of having high activation (levels 3 or 4 vs levels 1 or 2) in association with age (for every 10 years: aOR 0.79 [95% CI: 0.71 – 0.87]) and male sex (0.72 [0.53 – 0.96]). Compared to having less than high school diploma, high school diploma and college were associated with high activation (2.36 [1.60 – 3.47], and 3.52 [2.25 – 5.54] respectively). HD center differences remained significant after adjustment. However, vintage, race, and ethnicity did not have a significant association with activation in the adjusted model.


Patient activation is low in a high proportion of HD patients. Older age, less education and male gender were associated with lower activation. This study is the first to report activation status among individuals on HD in the US, identifying an opportunity to direct resources to high-risk groups and develop programs to improve activation.