Graduation Date

Summer 8-14-2015

Document Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Lani Zimmerman

Second Advisor

Bunny Pozehl

Third Advisor

Melody Hertzog


Post-hospitalization care transition is a vulnerable time for multimorbid patients. Self-management challenges happen due to acute symptoms and complex new treatment plans. Literature suggests higher activated patients have better outcomes; however, there is little research that identifies determinants that predict patient activation in the multimorbid hospitalized patient. Understanding predictive factors will facilitate planning interventions that promote self-management of multimorbid conditions. The purpose of this dissertation was to identify determinants that predict patient activation in patients with multimorbidity at discharge from the hospital.

A descriptive, predictive research study was conducted with 200 hospitalized multimorbid patients discharged to home. Their mean age was 63.7 (SD = 14.2); they were primarily Caucasian (n = 188, 94%); and female (n = 117, 58.5%). The mean Patient Activation Measure (PAM) score was 60.3 (SD = 14.6); 40 were level 1 (20%); 39 were level 2 (19.5%), 52 were level 3 (26%), and 69 were level 4 (34.5%).

There were significant relationships between PAM levels and several determinants. Patients in lower PAM levels needed more assistance understanding health care materials; were more depressed; more fatigued; less satisfied with their social role; and less satisfied with their chronic illness care. Patients in lower PAM levels were rehospitalized and visited the emergency department within 30-days post-discharge more frequently than level 4 activation patients. Multinomial logistical regression indicated that the predictors as a set distinguished between levels of patient activation (χ2 = 73.34 (3), p = .001). Patients in level 1 were more likely to need assistance reading health care material compared to level 4 patients. Level 2 and 3 patients were less likely to be satisfied with their chronic illness care than level 4 patients.

This study demonstrates that lower patient activation level patients have lower literacy levels, are less satisfied with their chronic illness care, and have more health care utilization 30-days post-discharge. Focusing on literacy and satisfaction with chronic illness care may improve patient outcomes.

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