Results Summary

What was the research about?

Research has shown that people who feel confident about managing their health and are more engaged in their care often have better health than people who don’t have these traits. Researchers refer to these traits as patient activation and engagement.

In an earlier study, the research team made a list of 39 health clinic activities that support patient activation and engagement. For example, doctors can work with patients to set health goals.

In this study, the team asked clinic managers to rate how often their staff did these activities. The team then compared patients at clinics with high ratings with patients at clinics with low ratings. All patients in the study had diabetes, heart disease, or both.

What were the results?

After two years, the team didn’t find differences between patients at clinics with high ratings and patients at clinics with low ratings in

  • Ability to do daily physical activities
  • Ability to do social activities
  • Anxiety and depression
  • Experiences with health care
  • Confidence and ability to manage health and health care
  • Blood pressure, blood sugar levels, and cholesterol

Patients who reported more confidence and ability to manage their health also reported

  • Greater ability to do daily physical activities
  • Greater ability to do social activities
  • Less anxiety and depression

During interviews, many healthcare providers said that they didn’t understand or often carry out these activities.

Who was in the study?

The study included 1,291 patients with diabetes or heart disease. Of these patients, 57 percent were women. In addition, 42 percent of patients were ages 35–64, and 58 percent were 65 or older. All patients received care from 1 of 16 health clinics at two large healthcare systems in Chicago and Los Angeles. The team interviewed 103 doctors, nurses, medical assistants, and managers at the clinics.

What did the research team do?

The team sent the list of patient activation and engagement activities to managers at 71 health clinics in the two healthcare systems. The managers rated the extent to which their clinics did the activities. Then the team selected eight clinics with low scores and eight clinics with high scores for the study. Patients who received care at these clinics completed surveys. The team also looked at patients’ medical records. The team interviewed healthcare workers at the 16 clinics to ask about activities and challenges.

What were the limits of the study?

Health clinic managers may not have fully known the details of how their clinics carried out patient activation and engagement activities. So the high and low ratings may not have reflected actual clinic practices.

Future research could observe clinics directly to measure the activities.

How can people use the results?

Researchers can use the results to plan further studies to learn how patient activation and engagement activities at clinics affect patients’ health.

Final Research Report

View this project's final research report.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:

  • Reviewers thought the study was well conducted but asked for greater clarity to allow others to understand and build on the work. The reviewers asked the researchers to describe the survey in more detail and explain the timeline for data collection. The researchers undertook clarifying the report and the study’s limitations.
  • Given that more-intensive patient activation and engagement activities did not show an association with better patient-reported outcomes, reviewers asked that the researchers emphasize qualitative findings that may provide insight for future research directions. The researchers provided more details about the qualitative methods and results and highlighted qualitative findings in the discussion. They revised the discussion to more clearly link their recommendations to all of the study findings, rather than focusing only on what was statistically significant.
  • The reviewers noted that the conclusions and limitations of the report focused on how study implementation problems may have led to the lack of association between patient activation and engagement activities and patient-reported outcomes. The researchers revised their conclusions to acknowledge that even if they had fully implemented the patient activation and engagement activities, there may be no causal relationship to patient-reported outcomes. The researchers also explained that patient-reported outcomes might be influenced more by patients’ characteristics than by patient activation and engagement.

Conflict of Interest Disclosures

Project Information

Stephen Shortell, MBA, MPH, PhD
The Regents of the University of California, Berkeley
The Comparative Impact of Patient Activation and Engagement on Improving Patient-Centered Outcomes of Care in Accountable Care Organizations

Key Dates

July 2014
September 2018

Study Registration Information


Has Results
Award Type
Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
Populations Populations PCORI is interested in research that seeks to better understand how different clinical and health system options work for different people. These populations are frequently studied in our portfolio or identified as being of interest by our stakeholders. View Glossary
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: April 12, 2024