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]
^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.
^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. PMID19356881.
^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. PMID17170635. S2CID15473213.
^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. PMID18665059. S2CID433811.
^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. PMID18946947.
^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. PMID19419972. S2CID3692863.
^ abRogvi, 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. PMID22540962. S2CID31607495.
^ abRemmers, 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. PMID19888008. S2CID2687411.
^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. PMID21684030.