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Patient Activation Measure

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The Patient Activation Measure (PAM) is a commercial product which assesses an individual's knowledge, skill, and confidence for managing one's health and healthcare. Individuals who measure high on this assessment typically understand the importance of taking a pro-active role in managing their health and have the skills and confidence to do so.

The PAM survey measures patients on a 0–100 scale and can segment patients into one of four activation levels along an empirically derived continuum. Each activation level reveals insight into an array of health-related characteristics, including attitudes, motivators, behaviors, and outcomes.

Development and science

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PAM was developed using qualitative methods, Rasch analysis, and classical test theory psychometric methods. Developed by Judith Hibbard and colleagues at the University of Oregon, the resulting 13-item measure is a uni-dimensional, interval level, Guttman-like scale.[1][2] The PAM has strong psychometric properties, and has been translated into 22 different languages.[3] The measure is currently used to assess patient activation or engagement by researchers and healthcare organizations around the world.[4][5][6][7] PAM is licensed exclusively through healthcare technology company Phreesia following the acquisition of its original licensor, Insignia Health, in December 2021.[8]

There are a number of instruments measuring similar constructs, including My Health Confidence, Patient Health Engagement Scale, Stanford self-efficacy for managing chronic disease 6-item scale, ICECAP-A (the ICEpop CAPability measure for Adults),[9] the Health Literacy Questionnaire and the Health Confidence Score.[10]

Research

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Multiple studies show that PAM scores are predictive of most health behaviors, including preventive behaviors (e.g. obtaining screenings and immunizations); healthy behaviors (e.g. healthy diet and regular exercise); self-management behaviors (e.g. monitoring and medication management); and health information seeking.[11][12][13][14][15][16][17][18][19][20][21] Higher activated individuals also have better health outcomes and lower rates of costly utilization, such as emergency department use and hospitalizations.[11][19][20][21][22]

Further there is evidence that with support and appropriate interventions it is possible to increase activation levels in patients.[23][24][25][26][27] In patients with inflammatory arthritis, patient activation has been shown to be associated with self-efficacy, the illness beliefs about treatment, and health literacy.[28] This suggests that these predictors of patient activation could act as targets for intervention in this group of patients.

The Patient Activation Measure is being used in a number of ways to improve the delivery of health care, including:

  • a metric to assess the degree to which patients are prepared and able to self-manage
  • to tailor support and education to help patients increase in activation
  • to track the impact of interventions and tailored support on increasing patient activation levels
  • to segment an enrolled patient population, and direct more resources to low activated patients (a more efficient use of resources )
  • to use in population health management
  • to use in predictive modeling, by using both PAM scores and clinical data, it is possible to identify future high risk/high cost patients more accurately than just using clinical data[29]

References

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  1. ^ Hibbard, Judith; Stockard, J; Mahoney, ER; Tusler, M (August 2004). "Development of the Patient Activation Measure (PAM): Conceptualizing and measuring activation in patients and consumers". Health Services Research. 39 (4): 1005–10026. doi:10.1111/j.1475-6773.2004.00269.x. PMC 1361049. PMID 15230939.
  2. ^ Hibbard, Judith; Mahoney, Eldon R.; Stockard, Jean; Tusler, Martin (December 2005). "Development and testing of a short form of the patient activation measure". Health Services Research. 40 (6): 1918–1930. doi:10.1111/j.1475-6773.2005.00438.x. PMC 1361231. PMID 16336556.
  3. ^ Hibbard, Judith (27 July 2014). deBronkart, e-Patient Dave (ed.). "[Comment on] The Patient Activation Measure (PAM): a framework for developing patient engagement". e-patients.net. Society for Participatory Medicine.
  4. ^ Rademakers, Jany; Nijman, Jessica; van der Hoek, Lucas; Heijmans, Monique; Rijken, Mieke (31 July 2012). "Measuring patient activation in the Netherlands: translation and validation of the American short form Patient Activation Measure (PAM13)". BMC Public Health. 12: 577. doi:10.1186/1471-2458-12-577. PMC 3490810. PMID 22849664.
  5. ^ Brenk-Franz, K; Hibbard, JH; Herrmann, WJ; Freund, T; Szecsenyi, J; Djalali, S; Steurer-Stey, C; Sönnichsen, A; Tiesler, F; Storch, M; Schneider, N; Gensichen, J (30 September 2013). "Validation of the German version of the patient activation measure 13 (PAM13-D) in an international multicentre study of primary care patients". PLOS ONE. 8 (9): e74786. doi:10.1371/journal.pone.0074786. PMC 3787015. PMID 24098669.
  6. ^ Fujita, Emi; Kuno, Eri; Kato, Daiji; Kokochi, Mariko; Uehara, Kumi; Hirayasu, Yoshio (15 August 2010). "精神の健康管理への積極性評価尺度(Patient Activation Measure 13 for Mental Health; PAM13-MH)日本語版の開発" [Development and Validation of the Japanese Version of the Patient Activation Measure 13 for Mental Health]. Seishin Igaku (Clinical Psychiatry) (in Japanese). 52: 765–772. doi:10.11477/mf.1405101678.
  7. ^ Steinsbekk, A (23 October 2008). "Måling av effekt av pasientopplæring" [Patient Activation Measure]. Tidsskrift for den Norske Lægeforening (in Norwegian). 128 (20): 2316–2318. PMID 19096487.
  8. ^ "Phreesia Announces Acquisition of Insignia Health, LLC, Redoubling Its Commitment to Improve Patients' Experience and Outcomes". Phreesia. 2021-12-13. Retrieved 2022-01-07.
  9. ^ Al-Janabi, Hareth (2011). "Development of a self-report measure of capability wellbeing for adults: the ICECAP-A". Quality of Life Research. 21 (1): 167–176. doi:10.1007/s11136-011-9927-2. PMC 3254872. PMID 21598064.
  10. ^ Benson, Tim; Potts, Henry WW; Bark, Pippa; Bowman, Clive (June 2019). "Development and initial testing of a Health Confidence Score (HCS)". BMJ Open Quality. 8 (2): e000411. doi:10.1136/bmjoq-2018-000411. PMC 6568167. PMID 31259277.
  11. ^ a b Greene, Jessica; Hibbard, Judith H. (May 2012). "Why Does Patient Activation Matter? An Examination of the Relationship Between Patient Activation and Health-Related Outcomes". Journal of General Internal Medicine. 27 (5): 520–6. doi:10.1007/s11606-011-1931-2. PMC 3326094. PMID 22127797.
  12. ^ Hibbard, Judith; Mahoney, ER; Stock, R; Tusler, M (August 2007). "Do increases in patient activation result in improved self-management behaviors?". Health Services Research. 42 (4): 1443–1463. doi:10.1111/j.1475-6773.2006.00669.x. PMC 1955271. PMID 17610432.
  13. ^ Fowles, Jinnet Briggs; Terry, Paul; Xi, Min; Hibbard, Judith; Bloom, Christine Taddy; Harvey, Lisa (October 2009). "Measuring self-management of patients' and employees' health: further validation of the Patient Activation Measure (PAM) based on its relation to employee characteristics". Patient Education and Counseling. 77 (1): 116–122. doi:10.1016/j.pec.2009.02.018. PMID 19356881.
  14. ^ Mosen, David M.; Schmittdiel, Julie; Hibbard, Judith; Sobel, David; Remmers, Carol; Bellows, Jim (January–March 2007). "Is patient activation associated with outcomes of care for adults with chronic conditions?". Journal of Ambulatory Care Management. 30 (1): 21–29. doi:10.1097/00004479-200701000-00005. PMID 17170635. S2CID 15473213.
  15. ^ Becker, Edmund R.; Roblin, Douglas W. (August 2008). "Translating primary care practice climate into patient activation: the role of patient trust in physician". Medical Care. 46 (8): 795–805. doi:10.1097/mlr.0b013e31817919c0. PMID 18665059. S2CID 433811.
  16. ^ Hibbard, Judith; Cunningham, PJ (October 2008). "How engaged are consumers in their health and health care, and why does it matter?". Research Brief. 8 (8): 1–9. PMID 18946947.
  17. ^ Tabrizi, Jafar S.; Wilson, Andrew J.; O'Rourke, Peter K. (18 December 2010). "Customer Quality and Type 2 Diabetes from the Patients' Perspective: A Cross-Sectional Study". Journal of Research in Health Sciences. 10 (2): 69–76. PMID 22911927.
  18. ^ Rask, Kimberly J.; Ziemer, David C.; Kohler, Susan A.; Hawley, Jonathan N.; Arinde, Folakemi J.; Barnes, Catherine S. (July–August 2009). "Patient activation is associated with healthy behaviors and ease in managing diabetes in an indigent populations". Diabetes Educator. 35 (4): 622–630. doi:10.1177/0145721709335004. PMID 19419972. S2CID 3692863.
  19. ^ a b Rogvi, S; Tapager, I; Almdal, TP; Schiøtz, ML; Willaing, I (October 2012). "Patient factors and glycaemic control: associations and explanatory power". Diabetic Medicine. 29 (10): e382–9. doi:10.1111/j.1464-5491.2012.03703.x. PMID 22540962. S2CID 31607495.
  20. ^ a b Salyers, Michelle P.; Matthias, Marianne S.; Spann, Crystal L.; Lydick, Jennifer M.; Rollins, Angela L.; Frankel, Richard M. (November 2009). "The role of patient activation in psychiatric visits". Psychiatric Services. 60 (11): 1535–1539. doi:10.1176/appi.ps.60.11.1535. PMC 2777630. PMID 19880475.
  21. ^ a b Remmers, Carol; Hibbard, Judith; Mosen, David M.; Wagenfield, Morton; Hoy, Robert E.; Jones, Ches (October–December 2009). "Is patient activation associated with future health outcomes and healthcare utilization among patients with diabetes?". Journal of Ambulatory Care Management. 32 (4): 320–327. doi:10.1097/jac.0b013e3181ba6e77. PMID 19888008. S2CID 2687411.
  22. ^ Begum, Nelufa; Donald, Maria; Ozolins, Ieva Z.; Dower, Jo (August 2011). "Hospital admissions, emergency department utilisation and patient activation for self-management among people with diabetes". Diabetes Research and Clinical Practice. 93 (2): 260–267. doi:10.1016/j.diabres.2011.05.031. PMID 21684030.
  23. ^ Lorig, K; Ritter, PL; Laurent, DD; Plant, K; Green, M; Jernigan, VB; Case, S (June 2010). "Online Diabetes Self-Management Program: A randomized study". Diabetes Care. 33 (6): 1275–1281. doi:10.2337/dc09-2153. PMC 2875437. PMID 20299481.
  24. ^ Druss, Benjamin G.; Zhao, Liping; von Esenwein, Silke A.; Bona, Joseph R.; Fricks, Larry; Jenkins-Tucker, Sherry; Sterling, Evelina; DiClemente, Ralph; Lorig, Kate (May 2010). "The Health and Recovery Peer (HARP) Program: a peer-led intervention to improve medical self-management for persons with serious mental illness". Schizophrenia Research. 118 (1–3): 264–270. doi:10.1016/j.schres.2010.01.026. PMC 2856811. PMID 20185272.
  25. ^ Terry, Paul E.; Fowles, Jinnet Briggs; Xi, Min; Harvey, Lisa (November–December 2011). "The ACTIVATE study: results from a group-randomized controlled trial comparing a traditional worksite health promotion program with an activated consumer program". American Journal of Health Promotion. 26 (2): e64–73. doi:10.4278/ajhp.091029-quan-348. PMID 22040398. S2CID 25178967.
  26. ^ Shively, MJ; Gardetto, NJ; Kodiath, MF; Kelly, A; Smith, TL; Stepnowsky, C; Maynard, C; Larson, CB (January–February 2013). "Effect of Patient Activation on Self-Management in Patients with Heart Failure". Journal of Cardiovascular Nursing. 28 (1): 20–34. doi:10.1097/JCN.0b013e318239f9f9. PMID 22343209. S2CID 26441995.
  27. ^ Hibbard, Judith H.; Greene, Jessica; Tusler, Martin (15 June 2009). "Improving the outcomes of disease management by tailoring care to the patient's level of activation". American Journal of Managed Care. 15 (6): 353–360. PMID 19514801.
  28. ^ Jones, Bethan; Ndosi, Mwidimi; Hunt, Andrew; Harcourt, Diana; Dures, Emma (2021-11-05). "Factors associated with patient activation in inflammatory arthritis: a multisite cross-sectional study". Rheumatology Advances in Practice. 5 (Supplement_2): ii35–ii44. doi:10.1093/rap/rkab053. ISSN 2514-1775. PMC 8570153. PMID 34755027.
  29. ^ Hibbard, Judith (March 2016). "Adding A Measure Of Patient Self-Management Capability To Risk Assessment Can Improve Prediction Of High Costs". Health Affairs. 35 (3): 489–494. doi:10.1377/hlthaff.2015.1031. PMID 26953304.
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