{"id":16588,"date":"2014-08-09T09:00:44","date_gmt":"2014-08-09T13:00:44","guid":{"rendered":"http:\/\/pmedicine.org\/epatients\/?p=16588"},"modified":"2020-07-25T09:26:52","modified_gmt":"2020-07-25T13:26:52","slug":"new-evidence-engaged-activated-patients-do-better-and-cost-less","status":"publish","type":"post","link":"https:\/\/participatorymedicine.org\/epatients\/2014\/08\/new-evidence-engaged-activated-patients-do-better-and-cost-less.html","title":{"rendered":"Longitudinal study: engaged (activated) patients do better and cost *less.*"},"content":{"rendered":"

\"Health<\/a>This article was part of the big Health Affairs issue “New Era of Patient Engagement” (Feb 2013) which Ileana Balcu blogged about<\/a> at the time.<\/em><\/p>\n

I’ve long been a fan of the Patient Activation Measure, which I\u00a0wrote about here three years ago in The Patient Activation\u00a0\u00a0Measure (PAM): a framework for developing patient engagement<\/a>.\u00a0It’s a straightforward questionnaire that assesses how activated \/ awakened \/ engaged someone is regarding their health, and it has a full decade of robust studies demonstrating that a person’s PAM score predicts many different outcomes. It’s a heck of a tool. (No, I’m not involved with the company.)<\/p>\n

Here, I want to report on an important paper<\/a>\u00a0in the\u00a0Health Affairs\u00a0<\/em>policy journal\u00a0on a new dimension\u00a0(the cost of a person’s care), discuss the report’s\u00a0probable policy impact, and propose that we take the concept an important step further.<\/p>\n

Optional background:<\/strong> If you’re interested in understanding what makes a difference, I urge you to go read that post from three\u00a0years ago, including its dozens of comments. They\u00a0really\u00a0<\/em>get into what we know so far, and probe into what we think beyond that. Dr. Hibbard herself responded with great additional info.<\/p>\n

First: what activation is (or more precisely, what the PAM measures)<\/h3>\n

From the post 3 years ago:
\n<\/p>\n

Thirteen questions are asked, and patients are scored as level 1, 2, 3 or 4:<\/p>\n

    \n
  1. Does not yet believe they have active\/important role<\/li>\n
  2. Lack confidence and knowledge to take action<\/li>\n
  3. Beginning to take action<\/li>\n
  4. Maintaining behavior over time<\/li>\n<\/ol>\n<\/blockquote>\n

    Previous studies on the impact of activation (i.e. PAM score)<\/h3>\n

    Dozens of studies have found correlations between PAM score and many measures, e.g.<\/p>\n

    The PAM has been successfully used to predict outcomes with a wide range of conditions including: serious mental health diagnosis, heart disease, multiple scelorisis, COPD, inflammatory bowel syndrome, hypertension, asthma, recovery after spine surgery, AIDS, and diabetes. Studies have also shown that the PAM is predictive of outcomes for those who are multi-morbid (4 or more conditions).<\/p><\/blockquote>\n

    (Source: a comment<\/a> on the original post by Dr. Hibbard; in a later comment she gave references.)<\/p>\n

    The current study<\/h3>\n

    The full text is behind a paywall, but I subscribe… here’s the gist. From the abstract:<\/p>\n

    In an analysis of 33,163 patients … patients with the lowest activation levels had predicted average costs that were 8 percent higher in the base year and 21 percent higher in the first half of the next year than the costs of patients with the highest activation levels….<\/p>\n

    What\u2019s more, patient activation was a significant predictor of cost even after adjustment for a commonly used \u201crisk score\u201d specifically designed to predict future costs.<\/p><\/blockquote>\n

    The paper reports results for all patients, and separately for chronic conditions: high cholesterol, high blood pressure, etc. In almost every case there was a strong correlation between PAM score and how much the health system spent on the patient.<\/p>\n

    There’s real cause for optimism here, because<\/p>\n