Measuring self-management of patients’ and employees’ health: Further validation of the Patient Activation Measure (PAM) based on its relation to employee characteristics

Fowles, Jinnet B.; Terry, Paul E.; Xi, Min; Hibbard, Judith H.; Bloom, Christine Taddy; Harvey, Lisa

doi:10.1016/j.pec.2009.02.018

Cited by 193 publications

(194 citation statements)

References 14 publications

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“…28 Measures The Patient Activation Measure consists of thirteen items that form a scale with strong psychometric properties. [6][7][8][9][10][11][12] The items are statements about managing one's own health, which respondents answer with degrees of agreement or disagreement. The statements focus on confidence, beliefs, knowledge, and skills, such as "I know how to prevent problems with my health" and "I am confident that I can tell a doctor my concerns, even when he or she does not ask."…”

Section: Study Data and Methodsmentioning

confidence: 99%

“…[6][7][8][9][10][11][12][13] More activated patients are also more likely to engage in healthy behavior and to seek out and use health information, compared to less activated patients. [12][13][14][15] There is evidence that patients who are more activated are less likely to be obese or to smoke, while being more likely to have clinical indicators that fall within normal parameters-such as normal blood pressure, cholesterol, and hemoglobin A1c levels-in contrast to patients who are less activated.…”

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confidence: 99%

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Patients With Lower Activation Associated With Higher Costs; Delivery Systems Should Know Their Patients’ ‘Scores’

2013

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Patient activation is a term that describes the skills and confidence that equip patients to become actively engaged in their health care. Health care delivery systems are turning to patient activation as yet another tool to help them and their patients improve outcomes and influence costs. In this article we examine the relationship between patient activation levels and billed care costs. In an analysis of 33,163 patients of Fairview Health Services, a large health care delivery system in Minnesota, we found that patients with the lowest activation levels had predicted average costs that were 8 percent higher in the base year and 21 percent higher in the first half of the next year than the costs of patients with the highest activation levels, both significant differences. What's more, patient activation was a significant predictor of cost even after adjustment for a commonly used "risk score" specifically designed to predict future costs. As health care delivery systems move toward assuming greater accountability for costs and outcomes for defined patient populations, knowing patients' ability and willingness to manage their health will be a relevant piece of information integral to health care providers' ability to improve outcomes and lower costs.

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Section: Study Data and Methodsmentioning

confidence: 99%

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confidence: 99%

Patients With Lower Activation Associated With Higher Costs; Delivery Systems Should Know Their Patients’ ‘Scores’

2013

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“…Prior studies have found a difference of at least 5 points to be meaningful. [49][50][51] Our modified positive deviance approach used data on the change in PAM scores to identify those primary care clinicians whose patients' scores increased the most and the least. We then conducted in-depth interviews with these positive and negative deviants, to distill the differentiating strategies used by top performers to support self-management and behavior change.…”

Section: Methodsmentioning

confidence: 99%

Supporting Patient Behavior Change: Approaches Used by Primary Care Clinicians Whose Patients Have an Increase in Activation Levels

et al. 2016

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PURPOSE We aimed to identify the strategies used to support patient behavior change by clinicians whose patients had an increase in patient activation.METHODS This mixed methods study was conducted in collaboration with Fairview Health Services, a Pioneer Accountable Care Organization. We aggregated data on the change in patient activation measure (PAM) score for 7,144 patients to the primary care clinician level. We conducted in-depth interviews with 10 clinicians whose patients' score increases were among the highest and 10 whose patients' score changes were among the lowest. Transcripts of the interviews were analyzed to identify key strategies that differentiated the clinicians whose patients had top PAM change scores. RESULTSClinicians whose patients had relatively large activation increases reported using 5 key strategies to support patient behavior change (mean = 3.9 strategies): emphasizing patient ownership; partnering with patients; identifying small steps; scheduling frequent follow-up visits to cheer successes, problem solve, or both; and showing caring and concern for patients. Clinicians whose patients had lesser change in activation were far less likely to describe using these approaches (mean = 1.3 strategies). Most clinicians, regardless of group, reported developing their own approach to support patient behavior change. Those whose patients showed high activation change reported spending more time with patients on counseling and education than did those whose patients showed less improvement in activation.CONCLUSIONS Clinicians vary in the strategies they use to promote behavior change and in the time spent with patients on such activities. The 5 key strategies used by clinicians with high patient activation change are promising approaches to supporting patient behavior change that should be tested in a larger sample of clinicians to validate their effectiveness. 2016;14:148-154. doi:10.1370/afm.1904. Ann Fam Med INTRODUCTIONT hrough policies such as pay for performance and public reporting of clinicians' quality of care, clinicians are increasingly responsible for their patients' care outcomes. [1][2][3][4] Yet, for health outcomes to improve, patients must do their part, following through on treatment regimens and making recommended lifestyle changes.5-7 Given the key role that patients play in determining health outcomes, policy makers have made patient engagement and patient activation a major focus, including embedding approaches for increasing engagement in the Patient Protection and Affordable Care Act. 8,9 Patient activation, which is defined as having the knowledge, confidence, and skills to take care of one's health and health care, has been shown to be associated with a broad range of health-related outcomes, including better self-management and clinical indicators, fewer hospitalizations, and lower health care costs. [10][11][12][13][14][15][16][17][18][19][20] [34][35][36] Also, patients' assessment of clinician support of the chronic care model has been associated with hig...

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“…Moreover, those who score higher are more likely to avoid health-damaging behavior such as smoking and illegal drug use. 1,2,[8][9][10][11][12][13][14][15] Less activated patients are also three times as likely to have unmet medical needs and twice as likely to delay medical care, compared with more activated patients. 13 Highly activated patients are two or more times as likely as those with low activation levels to prepare questions for a visit to the doctor; to know about treatment guidelines for their condition; and to seek out health information, including comparisons of the quality of health care providers.…”

Section: Evidence Of Better Health Outcomesmentioning

confidence: 99%

What The Evidence Shows About Patient Activation: Better Health Outcomes And Care Experiences; Fewer Data On Costs

2013

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Patient engagement is an increasingly important component of strategies to reform health care. In this article we review the available evidence of the contribution that patient activation-the skills and confidence that equip patients to become actively engaged in their health care-makes to health outcomes, costs, and patient experience. There is a growing body of evidence showing that patients who are more activated have better health outcomes and care experiences, but there is limited evidence to date about the impact on costs. Emerging evidence indicates that interventions that tailor support to the individual's level of activation, and that build skills and confidence, are effective in increasing patient activation. Furthermore, patients who start at the lowest activation levels tend to increase the most. We conclude that policies and interventions aimed at strengthening patients' role in managing their health care can contribute to improved outcomes and that patient activation can-and should-be measured as an intermediate outcome of care that is linked to improved outcomes.

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Measuring self-management of patients’ and employees’ health: Further validation of the Patient Activation Measure (PAM) based on its relation to employee characteristics

Cited by 193 publications

References 14 publications

Patients With Lower Activation Associated With Higher Costs; Delivery Systems Should Know Their Patients’ ‘Scores’

Patients With Lower Activation Associated With Higher Costs; Delivery Systems Should Know Their Patients’ ‘Scores’

Supporting Patient Behavior Change: Approaches Used by Primary Care Clinicians Whose Patients Have an Increase in Activation Levels

What The Evidence Shows About Patient Activation: Better Health Outcomes And Care Experiences; Fewer Data On Costs

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