Compared with highly activated patients ( PAM Level 4 ) , a higher rate of 30-day post-discharge hospital utilization was observed for patients at lower levels of activation ( PAM Level 1 , incident rate ratio [ IRR ] 1.75 , 95 % CI ,1.18 to 2.60 ) and ( PAM Level 2 , IRR 1.50 , 95 % CI 1.06 to 2.13 ) .
