Patient Activation Measure ( PAM)

Owned by Mohammad Al-Ubaydli
Last updated: Jun 23, 2023 by Maria Xenou (Unlicensed)
5 min read

The Patient Activation Measure (PAM) is a well-tested measure that predicts health outcomes. PAM scores measure self-management behaviours and determine over 50% of their risk for illness and premature death. Some organisations have measured PAM scores before and after using PKB with patients and found that PKB improves PAM scores. This allows identifying a short-term improvement with long-term implications. PKB encourages all its customers to measure PAM scores for patients.

PKB has done some literature review on PAM - Patient Activation Measure.

Introduction

The Patient Activation Measure (PAM) is a well-tested measure that predicts health outcomes. Some organisations have measured PAM scores before and after using PKB with patients and found that PKB improves PAM scores. This allows identifying a short-term improvement with long-term implications. PKB encourages all its customers to measure PAM scores for patients.

Using PAM scores with PKB

If are considering measuring PAM scores of your patients who have PKB please contact the PKB research team on research@patientsknowbest.com. PKB has pre-paid the license fee for PAM measurements to make the tool available free of charge to customers running research studies. The PKB research team can also work with your research team to provide advice on study design and roll-out protocols.

Note that PAM questions should not be set up as questionnaires inside the PKB medical record. Practically, this is because PAM scores are calculated by the software of PAM's creators, Insignia Health. So if your patients enter their answers into PKB then you will have to re-enter their answers into Insignia Health's PAM score calculator. Better to have the patients enter the answers directly into the PAM scoring software. Clinically, this is because you and your patient should not be storing the answers to PAM questions into the PKB medical record. Knowing that every clinician and carer can see their answers may change the answers a patient gives and so affect the accuracy of the PAM score. The PKB team can help you with the right protocol to administer the PAM questionnaire.

PKB also recommends providing controls for PAM scores conclusions to matter. Measure PAM for patients who register for PKB, and those who do not. For those who register for PKB, measure PAM before and six months after registration. And for best practice, randomise which patients are offered PKB so that a patient's interest in registering to see their data does not become a confounding variable for patients with pre-existing high activation measures. We already know that patients with high activation (high PAM score) want to look at their health information. The research question is whether looking at health information raises activation.

Background about PAM scores

The information in this section is part of Insignia Health's formal training on PAM. PKB provides this tutorial as a quick introduction but this is not comprehensive or formal training.

PAM scores measure self-management behaviours and determine over 50% of their risk for illness and premature death.

 

Over 500 studies support the validity of PAM scores and this has led to the adoption of the measure by a wide variety of organisations. In the USA, Accountable Care Organizations use the measure to determine patient improvement. 27 of the 33 measures of ACO quality are within a patient's power.

 

The PAM score places a patient into one of 4 levels. Levels 1 and 2 are Low PAM scores while 3 and 4 are High PAM scores.

The difference between Low and High is dramatic.

 

PAM Level 1

Level 1 patients have a 51% likelihood of a new chronic condition within 2 years, a 62% likelihood of an avoidable hospitalisation compared to a level 4, and a 32% likelihood of keeping an appointment that they made with their provider. They lack basic knowledge, have poor self-awareness, little goal orientation, poor medication adherence, few self-management skills, very low confidence and are passive in their care.

 

 

To help Level 1 patients, build self-awareness and understanding of their role; keep it simple, do not overwhelm them; praise early and often; let the patient guide you and their goals; build knowledge and reduce anxiety; focus on easy and realistic goals.

 

PAM Level 2

Level 2 patients have a 23% likelihood of a new chronic condition within 2 years, a 44% likelihood of an avoidable hospitalisation compared to a level 4, and a 40% likelihood of keeping an appointment that they made with their provider. They have struggles with medications, inconsistent self-management, poor communication with care gives, large gaps in knowledge, basic self-management skills, very low confidence and are passive in their care.

 

 

 

To help Level 2 patients: build knowledge and confidence; keep it simple, do not overwhelm them; praise early and often; increase patients' role in their care; help reduce knowledge gaps; focus on problem-solving.

 

Low level PAM score patients need high touch and benefit a lot from coaching

Low level patients need high touch. This means less intense, shorter sessions, more often, is better.

 

Tailoring your interactions to meet their level of knowledge and confidence is necessary and there are lots of growth areas for each patient.

 

But these patients do grow a lot, benefiting from a provider's help.