The healthcare industry continues to shift toward patient-centered care, and patient activation has emerged as a critical concept for improving health outcomes. Activation refers to a patient's knowledge, skills, readiness to learn, and confidence in managing their health. 

The patient activation measures (PAM) survey is an evidence-based tool that enables healthcare providers to tailor interventions and support strategies for every patient based on their engagement level. Through PAM surveys and scores, clinicians can better understand how likely patients are to be engaged in managing their own health. 

With this goal in mind, let’s review the four levels of activation, discuss how PAM differs from patient engagement, and explore how to leverage technology to improve activation.

Patient Activation Measures: The Survey

The patient activation measure survey (PAM survey) is a peer-reviewed, patient-reported assessment tool developed by Dr. Judith Hibbard and her colleagues. The tool is grounded in a theoretical framework that emphasizes patient activation as critical to self-management and improved health outcomes.

The PAM survey or questionnaire consists of 13 or 22 items (depending on the version used), each reflecting a statement about health and self-management. Respondents rate their level of agreement with each statement on a four-point Likert scale, ranging from "strongly disagree" to "strongly agree." The responses are then used to calculate an overall PAM score of 0 to 100.

Patient activation scores are further divided into four levels of activation:

• Level 1: Less than or equal to 47 points, this represents low-level patient activation measures and correlates with patient respondents who may feel overwhelmed and struggle to participate in their own health. This demographic may include patients who are newly diagnosed or those who are experiencing progression of a chronic illness.
• Level 2: Correlating to a score between 47.1 and 55.1, this level consists of patients with some knowledge of their condition and care plan but who lack the confidence and skills to self-manage their own health effectively.
• Level 3: A score of 55.2 to 67, this level refers to patient respondents who are beginning to take action to manage their health conditions but who may have difficulty maintaining their care plans during times of stress or change.
• Level 4: Patients who score over 67 and utilize the highest patient activation measures, take an active role in managing their own health, and have adopted positive health behaviors, including self-care.

From Patient Activation to Engagement

Patient activation and engagement are closely related concepts with similar goals and potential benefits like better patient outcomes, fewer readmissions, and improved quality of life. But there are some important distinctions. Here is one example of a patient experience that highlights the differences and the interplay between patient activation and patient engagement:

When Sarah was diagnosed with Type 2 diabetes, she felt overwhelmed by the drastic lifestyle changes, new medication, and at-home glucose monitoring required to manage her health condition.

Consequently, she had a medical crisis and ended up in the emergency department. Fortunately, her care managers then devised a high-touch strategy with plenty of one-on-one education and planning based on her low levels of activation.

Thanks to hospital case management and social work interventions, Sarah felt more supported and became more confident in managing her diabetes. As her activation level increased, Sarah felt more empowered to engage with her healthcare providers, asking questions about her care plan and advocating for herself. 

She was soon able to navigate the healthcare system and work collaboratively with her healthcare team to figure out a self-care routine that would help her manage her chronic condition. Sarah's patient experience illustrates the power of patient activation in improving patient engagement and, ultimately, in promoting better health outcomes.

Leveraging HIT Tools to Measure the Impact of Activation 

Health information technology (HIT) plays a significant role in evaluating the impact of patient activation on health outcomes and costs by leveraging various tools, data sources, and analytical techniques. Here are some ways HIT can assess the effects of patient activation.

Electronic Health Records

Electronic health records (EHRs) serve as a valuable source of patient data, including medical histories, treatment plans, and health outcomes. By integrating PAM scores into EHR systems, healthcare organizations can track and analyze the relationship between patient activation levels and health outcomes over time.

Data Analytics

Advanced data analytics techniques, such as predictive modeling and machine learning, can help identify patterns and trends in the relationship between patient activation and health outcomes or costs. These insights can assist healthcare providers in designing targeted interventions, care plans, and support strategies for patients at different levels of activation, ultimately improving care quality and reducing costs.

Quality Measures and Key Performance Indicators

HIT tools can track and monitor relevant quality measures and performance indicators related to patient activation and patient self-management. These measures may include the levels of patient activation, patient experience, and patient satisfaction; medication adherence; hospital readmission rates; emergency department visits; and other metrics influenced by patients' knowledge, skills, and confidence in managing their own health care.

Telehealth and Remote Monitoring

Telehealth and remote monitoring technologies can facilitate continuous patient engagement, allowing healthcare providers to understand the impact that increased patient activation can have on health outcomes and costs. Clinicians can make more informed decisions about patient care plans and resource allocation by monitoring patients' health status and their adherence to treatment plans, and by promoting the self-management behaviors associated with high levels of activation.

Health Information Exchange 

By securely sharing patient data among various healthcare providers, health information exchange systems enable a more comprehensive view of a patient's health history and care journey. This information can be used to examine the impact of patient activation on health outcomes and costs across different care settings and providers. By sharing information among clinicians, it’s less likely that a patient will fall through the cracks, like our hypothetical patient Sarah did before her medical crisis.

Technology-Enabled Patient Activation Methods

Some of the ways to improve patient activation include providing patient education, engaging in shared decision-making, and offering a supportive environment.

Patient Education

Patient activation is more likely to occur when the patient is well-informed. To promote patient activation, healthcare providers need to provide accurate, relevant, and easy-to-understand health information to patients. 

Providing education materials (e.g., brochures, videos, and online resources), offering workshops, and conducting regular follow-up appointments or support sessions to address patients' concerns are some of the best ways to accomplish this. 

By providing quality patient education offerings, clinicians are giving some measure of control back to the patient. Patients can be empowered to make informed decisions about their health conditions and treatment options by being thoroughly informed about the range of interventions available and the possible health outcomes.

Shared Decision-Making

Involving patients in decision-making is a major factor in promoting patient activation and makes for a more positive patient experience. Shared decision-making encourages collaboration between the patient and their primary care clinician, health coach, mental healthcare providers, and specialty health providers. The benefit is that patients are able to express their preferences, values, and goals, while all the medical professionals can contribute their clinical expertise. 

Technology enables shared decision-making by helping patients and clinicians work together to develop personalized self-care plans. Through shared decision-making, patients are more likely to feel invested in their treatment, leading to higher patient engagement and levels of activation, as well as increased adherence to care recommendations.

Supportive Environment

Fostering patient activation requires a supportive environment. Healthcare organizations that offer patients, their families, and their caregivers emotional support resources can use patient engagement technology to promote open communication and self-care. Supportive environments increase patient engagement and activation by helping them feel understood and valued. 

In particular, patients with chronic diseases, progressive health conditions, or those in need of chronic care may especially benefit from health coaching and follow-up check-ins. Such efforts can significantly improve quality of life for this patient population. 

Choose the CaredFor App for Activated Patients

The CaredFor app by ContinuumCloud stands out as a comprehensive patient activation tool that meets the essential criteria for promoting patient engagement and facilitating the measuring of patients’ level of activation. 

With a wide array of customizable features and a user-friendly interface, the CaredFor app helps clinicians to encourage patient self-management and self-efficacy. It allows behavioral health patients to take an active role in their own health journey, while providing healthcare organizations with the necessary tools to assess and improve patient activation—and ultimately, patient health outcomes.

Features include an extensive library of templates that enable healthcare providers to design and implement personalized content that resonates with their patients. The app also empowers patients to enhance their knowledge, skills, and confidence in taking an active role in managing their own health by providing educational materials, interactive patient education resources, and support services.

To learn more about how the CaredFor app can benefit your organization and enhance patient activation and the patient experience, connect with ContinuumCloud today.