Can This Metrics-Based Tool Improve Patient Health?

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The Patient Activation Measure® (PAM®) tool, according to those implementing and overseeing its use, is making a difference. It comprises a set of progressively difficult questions (typically 10) that indicate a person’s level of abilities, from understanding their responsibility to care for themselves to sticking to routines even in times of stress and duress. It’s in use across the country by Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs), made available from the QIN National Coordinating Center (NCC).

It’s the best tool we’ve found so far, validated by over 300 studies, that measures patient activation. It’s great for understanding what activation really means,” said Risa Hayes, program specialist at the QIN NCC.

Hayes said that activation refers primarily to three key areas of measure: 

  • Knowledge of what to do and how to carry out the activities necessary for managing wellness — including knowing when and in what way to seek medical attention
  • Skills to carry out those activities, such as administering medications or, for diabetics, checking blood sugar daily
  • Confidence to do what needs to be done or talk to the right person about doing it

According to Hayes, the PAM tool, which is licensed by Insignia Health, not only helps identify the specific level of care and support patients need at a given time, but also informs their providers and caregivers on the best ways to deliver it.

Too often, Hayes said, patients are diagnosed and/​or discharged and simply handed a stack of papers, which can overwhelm them when they’re already vulnerable, ill or exhausted. That paperwork also tends to be aimed at a patient with a higher activation level, or a state of mind where they can better understand and implement the information. 

The PAM tool is helping ease the burden, raise activation awareness and improve patient outcomes by giving care providers tools and training, including at the community level — and even right where patients live.

Case Study: WISH Program

In Montgomery County, Maryland, the Wellness and Independence for Seniors at Home (WISH) program, part of the Nexus Montgomery Regional Partnership consisting of six local hospitals, aims to keep seniors in place. Through WISH, care coordinators at 44 high-rise senior-living facilities in the county are using the PAM tool with proactive interventions for Medicare patients. One key goal is to reduce hospital readmissions.

The program involves partnerships between hospitals, care transitions coalitions, nursing facilities, home health agencies and other community organizations who refer patients from the senior buildings that could benefit from access to a health coach at home. The overall goal: to provide patients and staff with the PAM tool as well as training and education. The effort also includes members of the administration at the independent senior living facilities who see the residents every day, according to Carla Thomas, director of care transition at Health Quality Innovators (HQI), the QIN-QIO for Maryland and Virginia.

Anyone in the process can make a referral for someone they believe could benefit from a health coach — and access to the PAM tool.

We’re trying to keep people in the community and at home,” said Kelly Arthur, improvement consultant at HQI. By implementing a coaching model with multiple referrals being sent to the WISH program, which provides health coaches in the community, the PAM tool was the perfect fit for health coaches to determine patient needs and measure their progress. It became about the patient and the individualized ability to support them.”

With the help of the PAM tool, patients better understand the resources available to them, which in turn can help keep them at home — for example, they don’t visit the emergency department for an issue that could be addressed by a phone call with a nurse or another community-based program, Thomas noted.

According to Hayes, more than 7,413 PAM surveys have been completed by more than 4,937 individuals since the program began rolling out in 2015.

This is impacting patients positively because our providers and practitioners are doing a better job interacting with people, that social aspect beyond the clinical aspect,” Hayes said. We’re seeing an impact in how we practice and meeting people where they are.”