Patient activation, the measure of patients’ readiness and willingness to manage their own health care, is low among people receiving in-center hemodialysis, which is exacerbated because such centers are commonly set up for patients to passively receive care. In our pursuit of person-centered care and value-based medicine, enabling patients to take a more active role in their care can lead to healthy behaviors, with subsequent reductions in individual burden and costs to the health care system. To improve patient activation, we need to embrace a patient-first approach and combine it with ways to equip patients to thrive with self-management. This requires changes in the training of the health care team as well as changes in care delivery models, promoting interventions such as health coaching and peer mentoring, while leveraging technology to enable self-access to records, self-monitoring, and communication with providers. We also need health care policies that encourage a focus on patient-identified goals, including more attention to patient-reported outcomes. In this article, we review the current status of patient activation in dialysis patients, outline some of the available interventions, and propose steps to change the dynamics of the current system to move toward a more active role for patients in their care.

在接受中心血液透析的人群中，患者激活度（衡量患者准备和管理自己的医疗保健的意愿）较低，由于此类中心通常是为患者被动接受护理而设立的，因此这种情况更加严重。在我们追求以人为本的护理和基于价值的医学的过程中，让患者在他们的护理中发挥更积极的作用可以带来健康的行为，从而减少个人负担和医疗保健系统的成本。为了提高患者的积极性，我们需要采用患者至上的方法，并将其与使患者通过自我管理茁壮成长的方法相结合。这需要改变医疗保健团队的培训以及改变护理提供模式，促进健康指导和同伴指导等干预措施，同时利用技术实现对记录的自我访问、自我监控以及与供应商的沟通。我们还需要鼓励关注患者确定的目标的医疗保健政策，包括更多地关注患者报告的结果。在本文中，我们回顾了透析患者中​​患者激活的当前状态，概述了一些可用的干预措施，并提出了改变当前系统动态的步骤，以使患者在他们的护理中发挥更积极的作用。