Medicine: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

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

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

  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. 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. PMID 16336556. 
  3. ↑ Hibbard, Judith (27 July 2014). "[Comment on The Patient Activation Measure (PAM): a framework for developing patient engagement"]. Society for Participatory Medicine. http://e-patients.net/archives/2011/10/the-patient-activation-measure-pam-a-framework-for-developing-patient-engagement.html#comment-263236. 
  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. PMID 22849664. 
  5. ↑ Brenk-Franz, K; Hibbard, JH; Herrmann, WJ; Freund, T; Szecsenyi, J; Djalali, S; Steurer-Stey, C; Sönnichsen, A et al. (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. 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" (in Japanese). Seishin Igaku (Clinical Psychiatry) 52: 765–772. doi:10.11477/mf.1405101678. 
  7. ↑ Steinsbekk, A (23 October 2008). "Måling av effekt av pasientopplæring" (in Norwegian). Tidsskrift for den Norske Lægeforening 128 (20): 2316–2318. PMID 19096487. http://tidsskriftet.no/article/1748238. 
  8. ↑ "Phreesia Announces Acquisition of Insignia Health, LLC, Redoubling Its Commitment to Improve Patients' Experience and Outcomes" (in en-US). 2021-12-13. https://www.phreesia.com/2021/12/13/phreesia-announces-acquisition-of-insignia-health/. 
  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. 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. PMID 31259277. 
  11. ↑ 11.0 11.1 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. 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. 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. 
  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. 
  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. http://jrhs.umsha.ac.ir/index.php/JRHS/article/view/207/html. 
  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. 
  19. ↑ 19.0 19.1 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. 
  20. ↑ 20.0 20.1 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. PMID 19880475. 
  21. ↑ 21.0 21.1 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. 
  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. PMID 20299481. 
  24. ↑ Druss, Benjamin G.; Zhao, Liping; von Esenwein, Silke A.; Bona, Joseph R.; Fricks, Larry; Jenkins-Tucker, Sherry; Sterling, Evelina; DiClemente, Ralph et al. (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. 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. 
  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. 
  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. http://www.ajmc.com/journals/issue/2009/2009-06-vol15-n6/AJMC_09Jun_Hibbard_353to360/. 
  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" (in en). Rheumatology Advances in Practice 5 (Supplement_2): ii35–ii44. doi:10.1093/rap/rkab053. ISSN 2514-1775. PMID 34755027. PMC 8570153. https://academic.oup.com/rheumap/article/5/Supplement_2/ii35/6421475. 
  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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