Patient Activation Measure

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.{{cite journal|last1=Hibbard|first1=Judith |last2=Stockard|first2=J |last3=Mahoney|first3=ER |last4=Tusler|first4=M |title=Development of the Patient Activation Measure (PAM): Conceptualizing and measuring activation in patients and consumers|journal=Health Services Research|date=August 2004|volume=39|issue=4|pages=1005–10026|doi=10.1111/j.1475-6773.2004.00269.x|pmid=15230939|pmc=1361049}}{{cite journal|last1=Hibbard|first1=Judith |last2=Mahoney|first2=Eldon R. |last3=Stockard|first3=Jean |last4=Tusler|first4=Martin |title=Development and testing of a short form of the patient activation measure|journal=Health Services Research|date=December 2005|volume=40|issue=6|pages=1918–1930|doi=10.1111/j.1475-6773.2005.00438.x|pmid=16336556|pmc=1361231}} The PAM has strong psychometric properties, and has been translated into 22 different languages.{{cite web |last1=Hibbard |first1=Judith |editor-last1=deBronkart |editor1-first=e-Patient Dave |date=27 July 2014 |title=[Comment on] The Patient Activation Measure (PAM): a framework for developing patient engagement |website=e-patients.net |publisher=Society for Participatory Medicine |url=http://e-patients.net/archives/2011/10/the-patient-activation-measure-pam-a-framework-for-developing-patient-engagement.html#comment-263236 }} The measure is currently used to assess patient activation or engagement by researchers and healthcare organizations around the world.{{cite journal |last1=Rademakers |first1=Jany |last2=Nijman |first2=Jessica |last3=van der Hoek |first3=Lucas |last4=Heijmans |first4=Monique |last5=Rijken |first5=Mieke |title=Measuring patient activation in the Netherlands: translation and validation of the American short form Patient Activation Measure (PAM13) |journal=BMC Public Health |date=31 July 2012 |volume=12 |page=577 |doi=10.1186/1471-2458-12-577 |pmid=22849664 |pmc=3490810 |doi-access=free }}{{cite journal |last1=Brenk-Franz|first1=K |last2=Hibbard|first2=JH |last3=Herrmann|first3=WJ |last4=Freund|first4=T |last5=Szecsenyi|first5=J |last6=Djalali|first6=S |last7=Steurer-Stey|first7=C |last8=Sönnichsen|first8=A |last9=Tiesler|first9=F |last10=Storch|first10=M |last11=Schneider|first11=N |last12=Gensichen|first12=J |date=30 September 2013 |title=Validation of the German version of the patient activation measure 13 (PAM13-D) in an international multicentre study of primary care patients |journal=PLOS ONE |volume=8 |issue=9 |page=e74786 |doi=10.1371/journal.pone.0074786 |pmid=24098669 |pmc=3787015 |doi-access=free }}{{cite journal |last1=Fujita|first1=Emi |last2=Kuno|first2=Eri |last3=Kato|first3=Daiji |last4=Kokochi|first4=Mariko |last5=Uehara|first5=Kumi |last6=Hirayasu|first6=Yoshio |title=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 |trans-title=Development and Validation of the Japanese Version of the Patient Activation Measure 13 for Mental Health |language=Japanese |journal=Seishin Igaku (Clinical Psychiatry) |date=15 August 2010 |volume=52 |pages=765–772 |doi=10.11477/mf.1405101678 }}{{cite journal |last1=Steinsbekk |first1=A |title=Måling av effekt av pasientopplæring |trans-title=Patient Activation Measure |language=Norwegian |journal=Tidsskrift for den Norske Lægeforening |date=23 October 2008 |volume=128 |issue=20 |pages=2316–2318 |pmid=19096487 |url=http://tidsskriftet.no/article/1748238 }} PAM is licensed exclusively through healthcare technology company Phreesia following the acquisition of its original licensor, Insignia Health, in December 2021.{{Cite web|date=2021-12-13|title=Phreesia Announces Acquisition of Insignia Health, LLC, Redoubling Its Commitment to Improve Patients' Experience and Outcomes|url=https://www.phreesia.com/2021/12/13/phreesia-announces-acquisition-of-insignia-health/|access-date=2022-01-07|website=Phreesia|language=en-US}}

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),{{cite journal| doi =10.1007/s11136-011-9927-2 | volume=21 | title=Development of a self-report measure of capability wellbeing for adults: the ICECAP-A | year=2011 | journal=Quality of Life Research | pages=167–176 | last1 = Al-Janabi | first1 = Hareth | issue=1 | pmid=21598064 | pmc=3254872}} the Health Literacy Questionnaire and the Health Confidence Score.{{cite journal|last1=Benson |first1=Tim|last2=Potts|first2=Henry WW|last3=Bark|first3=Pippa|last4=Bowman|first4=Clive|title= Development and initial testing of a Health Confidence Score (HCS)|journal=BMJ Open Quality|date=June 2019|volume=8|issue=2|page=e000411|doi=10.1136/bmjoq-2018-000411|pmid=31259277|pmc=6568167|doi-access=free}}

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.{{cite journal |last1=Greene |first1=Jessica |last2=Hibbard |first2=Judith H. |title=Why Does Patient Activation Matter? An Examination of the Relationship Between Patient Activation and Health-Related Outcomes |journal=Journal of General Internal Medicine |date=May 2012 |volume=27 |issue=5 |pages=520–6 |doi=10.1007/s11606-011-1931-2 |pmid=22127797 |pmc=3326094 }}{{cite journal|last1=Hibbard|first1=Judith |last2=Mahoney|first2=ER |last3=Stock|first3=R |last4=Tusler|first4=M |title=Do increases in patient activation result in improved self-management behaviors?|journal=Health Services Research|date=August 2007|volume=42|issue=4|pages=1443–1463|doi=10.1111/j.1475-6773.2006.00669.x|pmid=17610432|pmc=1955271}}{{cite journal|last1=Fowles|first1=Jinnet Briggs |last2=Terry|first2=Paul |last3=Xi|first3=Min |last4=Hibbard|first4=Judith |last5=Bloom|first5=Christine Taddy |last6=Harvey|first6=Lisa |title=Measuring self-management of patients' and employees' health: further validation of the Patient Activation Measure (PAM) based on its relation to employee characteristics|journal=Patient Education and Counseling|date=October 2009|volume=77|issue=1|pages=116–122|doi=10.1016/j.pec.2009.02.018 |pmid=19356881}}{{cite journal |last1=Mosen|first1=David M. |last2=Schmittdiel|first2=Julie |last3=Hibbard|first3=Judith |last4=Sobel|first4=David |last5=Remmers|first5=Carol |last6=Bellows|first6=Jim |title=Is patient activation associated with outcomes of care for adults with chronic conditions?|journal=Journal of Ambulatory Care Management|date=January–March 2007|volume=30|issue=1|pages=21–29|doi=10.1097/00004479-200701000-00005 |pmid=17170635 |s2cid=15473213 }}{{cite journal |last1=Becker |first1=Edmund R. |last2=Roblin |first2=Douglas W. |title=Translating primary care practice climate into patient activation: the role of patient trust in physician |journal=Medical Care |date=August 2008 |volume=46 |issue=8 |pages=795–805 |doi=10.1097/mlr.0b013e31817919c0 |pmid=18665059 |s2cid=433811 }}{{cite journal |last1=Hibbard |first1=Judith |last2=Cunningham |first2=PJ |title=How engaged are consumers in their health and health care, and why does it matter? |journal=Research Brief |date=October 2008 |volume=8 |issue=8 |pages=1–9 |pmid=18946947 }}{{cite journal |last1=Tabrizi |first1=Jafar S. |last2=Wilson |first2=Andrew J. |last3=O'Rourke |first3=Peter K. |title=Customer Quality and Type 2 Diabetes from the Patients' Perspective: A Cross-Sectional Study |journal=Journal of Research in Health Sciences |date=18 December 2010 |volume=10 |issue=2 |pages=69–76 |url=http://jrhs.umsha.ac.ir/index.php/JRHS/article/view/207/html |pmid=22911927 }}{{cite journal|last1=Rask|first1=Kimberly J. |last2=Ziemer|first2=David C. |last3=Kohler|first3=Susan A. |last4=Hawley|first4=Jonathan N. |last5=Arinde|first5=Folakemi J. |last6=Barnes|first6=Catherine S. |title=Patient activation is associated with healthy behaviors and ease in managing diabetes in an indigent populations|journal=Diabetes Educator|date=July–August 2009|volume=35|issue=4|pages=622–630|doi=10.1177/0145721709335004 |pmid=19419972 |s2cid=3692863 }}{{cite journal |last1=Rogvi|first1=S |last2=Tapager|first2=I |last3=Almdal|first3=TP |last4=Schiøtz|first4=ML |last5=Willaing|first5=I |date=October 2012 |title=Patient factors and glycaemic control: associations and explanatory power |journal=Diabetic Medicine |volume=29 |issue=10 |pages=e382–9 |doi=10.1111/j.1464-5491.2012.03703.x |pmid=22540962 |s2cid=31607495 }}{{cite journal|last1=Salyers|first1=Michelle P. |last2=Matthias|first2=Marianne S. |last3=Spann|first3=Crystal L. |last4=Lydick|first4=Jennifer M. |last5=Rollins|first5=Angela L. |last6=Frankel|first6=Richard M. |title=The role of patient activation in psychiatric visits |journal=Psychiatric Services |date=November 2009 |volume=60 |issue=11 |pages=1535–1539 |doi=10.1176/appi.ps.60.11.1535 |pmid=19880475 |pmc=2777630 }}{{cite journal |last1=Remmers|first1=Carol |last2=Hibbard|first2=Judith |last3=Mosen|first3=David M. |last4=Wagenfield|first4=Morton |last5=Hoy|first5=Robert E. |last6=Jones |first6=Ches |title=Is patient activation associated with future health outcomes and healthcare utilization among patients with diabetes? |journal=Journal of Ambulatory Care Management |date=October–December 2009 |volume=32 |issue=4 |pages=320–327 |doi=10.1097/jac.0b013e3181ba6e77 |pmid=19888008 |s2cid=2687411 }} Higher activated individuals also have better health outcomes and lower rates of costly utilization, such as emergency department use and hospitalizations.{{cite journal |last1=Begum|first1=Nelufa |last2=Donald|first2=Maria |last3=Ozolins|first3=Ieva Z. |last4=Dower|first4=Jo |title=Hospital admissions, emergency department utilisation and patient activation for self-management among people with diabetes |journal=Diabetes Research and Clinical Practice |date=August 2011 |volume=93 |issue=2 |pages=260–267 |doi=10.1016/j.diabres.2011.05.031 |pmid=21684030 }}

Further there is evidence that with support and appropriate interventions it is possible to increase activation levels in patients.{{cite journal|last1=Lorig|first1=K |last2=Ritter|first2=PL |last3=Laurent|first3=DD |last4=Plant|first4=K |last5=Green|first5=M |last6=Jernigan|first6=VB |last7=Case|first7=S |title=Online Diabetes Self-Management Program: A randomized study|journal=Diabetes Care|date=June 2010|volume=33|issue=6|pages=1275–1281|doi=10.2337/dc09-2153|pmid=20299481|pmc=2875437}}{{cite journal |last1=Druss|first1=Benjamin G. |last2=Zhao|first2=Liping |last3=von Esenwein|first3=Silke A. |last4=Bona|first4=Joseph R. |last5=Fricks|first5=Larry |last6=Jenkins-Tucker|first6=Sherry |last7=Sterling|first7=Evelina |last8=DiClemente|first8=Ralph |last9=Lorig|first9=Kate |title=The Health and Recovery Peer (HARP) Program: a peer-led intervention to improve medical self-management for persons with serious mental illness |journal=Schizophrenia Research |date=May 2010 |volume=118 |issue=1–3 |pages=264–270 |doi=10.1016/j.schres.2010.01.026 |pmid=20185272 |pmc=2856811 }}{{cite journal |last1=Terry|first1=Paul E. |last2=Fowles|first2=Jinnet Briggs |last3=Xi|first3=Min |last4=Harvey|first4=Lisa |title=The ACTIVATE study: results from a group-randomized controlled trial comparing a traditional worksite health promotion program with an activated consumer program |journal=American Journal of Health Promotion |date=November–December 2011 |volume=26 |issue=2 |pages=e64–73 |doi=10.4278/ajhp.091029-quan-348 |pmid=22040398 |s2cid=25178967 }}{{cite journal |last1=Shively|first1=MJ |last2=Gardetto|first2=NJ |last3=Kodiath|first3=MF |last4=Kelly|first4=A |last5=Smith|first5=TL |last6=Stepnowsky|first6=C |last7=Maynard|first7=C |last8=Larson|first8=CB |date=January–February 2013 |title=Effect of Patient Activation on Self-Management in Patients with Heart Failure |journal=Journal of Cardiovascular Nursing |volume=28 |issue=1 |pages=20–34 |doi=10.1097/JCN.0b013e318239f9f9 |pmid=22343209 |s2cid=26441995 }}{{cite journal |last1=Hibbard |first1=Judith H. |last2=Greene |first2=Jessica |last3=Tusler |first3=Martin |title=Improving the outcomes of disease management by tailoring care to the patient's level of activation |journal=American Journal of Managed Care |date=15 June 2009 |volume=15 |issue=6 |pages=353–360 |url=http://www.ajmc.com/journals/issue/2009/2009-06-vol15-n6/AJMC_09Jun_Hibbard_353to360/ |pmid=19514801 }} In patients with inflammatory arthritis, patient activation has been shown to be associated with self-efficacy, the illness beliefs about treatment, and health literacy.{{Cite journal|last1=Jones|first1=Bethan|last2=Ndosi|first2=Mwidimi|last3=Hunt|first3=Andrew|last4=Harcourt|first4=Diana|last5=Dures|first5=Emma|date=2021-11-05|title=Factors associated with patient activation in inflammatory arthritis: a multisite cross-sectional study|url=https://academic.oup.com/rheumap/article/5/Supplement_2/ii35/6421475|journal=Rheumatology Advances in Practice|language=en|volume=5|issue=Supplement_2|pages=ii35–ii44|doi=10.1093/rap/rkab053|issn=2514-1775|pmc=8570153|pmid=34755027}} 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{{cite journal|last1=Hibbard|first1=Judith|title=Adding A Measure Of Patient Self-Management Capability To Risk Assessment Can Improve Prediction Of High Costs|journal=Health Affairs|date=March 2016|volume=35|issue=3|pages=489–494|doi=10.1377/hlthaff.2015.1031|pmid=26953304|doi-access=free}}

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Category:Health care