Introduction
In February of 2013, Health Affairs published an issue on the theme of the “New Era of Patient Engagement”. In this issue, patient activation is defined several times, each definition varying just slightly, however, the message is clear. Patient activation is “understanding one’s own role in the care process and having the knowledge, skills, and confidence to take on that role.” (Hibbard, 2013). Patient activation involves educating patients about their conditions and treatment options, giving them the confidence to make an informed decision, and supporting them in owning their healthcare.
Research has shown when patients understand their care options, actively participate in making decisions about their care, and act on those decisions, they have improved outcomes, lower costs of care, and improved satisfaction. Patient activation is a key driver to achieving the quadruple aim.
Tools for Measuring Activation
Patient Activation Measure (PAM)
Dr. Judith Hibbard set out to prove this theory when she and her colleagues developed the Patient Activation Measure (PAM). The PAM was developed to quantifiably measure the patients’ level of activation in one of the following four stages:
Stage 1: Patient believes engagement in their health is important
Stage 2: Patient has confidence and knowledge needed but isn’t ready to act
Stage 3: Patient takes actions to maintain and improve health
Stage 4: Patient maintains actions to maintain and improve health despite stress (Patient Activation Measure, 2016)
Dr. Hibbard’s PAM score is well-known in the industry but the tool is now licensed through Insignia Health which makes it financially unattainable for many facilities.
Chronic Disease Self-Efficacy Scale
This validated instrument was developed by the Stanford Education Research Center and measures a patient’s self-efficacy primarily in chronic disease interventions. There is a comprehensive version that measures ten scales (categories) and a shorter six scale version.
Patient Motivation Measure
Developed by the Altarum Institute, the goal of the ACE is to measure health engagement levels of both individuals and populations. It consists of 12 items that assess patient commitment, informed choice and navigation. The ACE is a validated instrument and incorporates Patient Activation Measure (PAM) levels in the results when using their reporting tool.
Patient Attitude, Motivation, and Perception Assessment
Developed by Psychology Services Limited out of the United Kingdom, this validated assessment is designed to identify a patients’ perceptions and attitudes that may be a barrier to motivation to change or engage in treatment. It contains three parts: the Patient Attitude Questionnaire (PAQ), the Patient Motivation Inventory (PMI) and the Patient Perception Questionnaire (PPQ). There is no cost to download the assessment: https://www.psychology-services.uk.com/resources.htm#resource-21
How’s Your Health
This brief survey is designed for patients to complete by answering questions about health, habits, knowledge, satisfaction, etc. The survey includes a summary of responses that the patient can print and share with their provider. Also available are action plans, self-management forms and recommended readings. The tool was developed by FNX Corporation and Trustees of Dartmouth College and has been in use for over 20 years. The survey is validated and is free for patients to take on their own. To take the assessment, visit https://howsyourhealth.org.
Providers can register for a unique code that allows them to customize the survey and receive individual patient reports. This service is free for up to 3,000 patients/users per year. Registration can be set up at https://howsyourhealth.org/static/professional.html. A sample patient report and additional resources for providers can be found at this site as well.
Who's Responsible for Patient Activation
Patient activation is the responsibility of all staff that interact with the patient before or during a visit. This includes phone contact, check-in, completing the intake, provider interaction and checkout. Throughout the process the opportunity for engagement may differ but all play an important role; the key is to engage the patient in learning and understanding their care.
Front desk – hands the patient a shared decision making tool and provides instructions for reviewing, next steps, and offers to answer any questions.
At intake – the nurse or medical assistant discusses proper positioning for taking home blood pressure readings while taking their blood pressure.
Provider – explains the condition in terms the patient understands, options for treatment, and recommendations for more information or refers the patient to the health educator or care manager.
At checkout – asks the patient what additional questions he or she has, advises them to keep their after-visit summary and care plan in a readily available location at home, and reminding them to call any questions.
These points of contact can help in activating the patient in their care.
Who's Responsible for Patient Activation
Patient activation is an “Always Event”, which means techniques to increase activation must be integrated into the way team members interact with all patients. The practice and providers need to commit to training staff in the levels of activation and patient education skills such as:
- Ask-Tell-Ask,
- Teach Back,
- Open-ended Questioning, and
- Active Listening
To learn more about these techniques refer to the Patient Education Tactics content.
Integrating specific activation tactics throughout the care team ensures a patient is engaged or working towards engagement in their health and care with every interaction, which will advance the patient through the PAM stages of to level four activation, “Patient maintains actions to maintain and improve health despite stress” This will improve patients’ experience and foster patient’s trust by showing continued commitment to patient activation (Always Events Toolkit, 2016)
