Monday, January 4, 2016

How Can We Measure Patient Engagement Levels?

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In the healthcare world, there is often discussion surrounding the need of patients to become engaged in their own care as well as how healthcare systems and providers can encourage engagement. This is especially true for those of us living with chronic illnesses which, according to the CDC, is now roughly half of the adult population here in the United States.

There is often a question as to how we can really track the engagement of the patient.

Earlier this decade, a group of professors at the University of Oregon developed a way to do just that - the Patient Activation Measure (PAM). PAM asks a series of 22 questions that help sort patients into four levels of activation. At the time this measure was created, the thought was that patients who are more activated and engaged in their healthcare will be able to care for themselves more effectively.

In March 2015, one of the originators of the PAM, Judith Hibbard, along with additional colleagues, conducted a study to test this hypothesis. Over a two-year period of time, the majority of patients studied stayed on the same activation level. There was some movement, though, in both directions. Health outcomes were also studied, with results indicating that the original hypothesis was true - not only is the activation level for a patient an indicator of future health, "health outcomes tend to change in the same direction [if there is movement], and costs follow as predicted" (Greene 2015, Pg 436). In fact, "less activated patients are almost twice as likely as more activated patient to be readmitted to the hospital within thirty days of a discharge" (Greene 2015, Pg 432).

The difficulty here is that those who have higher PAM scores tend to be those with higher education and socioeconomic status. How can we extend this idea to fit more of the patient world? After all, many of us live in poverty whether due to not being able to work at all or as much, living on disability, or the amount of money we have to spend on our medications and treatments.

We could discuss the strides being made to get internet access to all, including libraries having computers and even hotspots to check out and take home. However, then we need to consider the barriers to engaged patients who do their own research or track data. There are many providers who do not welcome these, let alone pictures of rashes and the like.

Patients, pharma, physicians, clinical staff, and more need to start thinking about what we can do to help each other become more knowledgeable about health. After all, 86% of health costs in 2010 were due to chronic illness.

Resources:

CDC - http://www.cdc.gov/chronicdisease/overview/

Hibbard 2004 - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361049/

Gonzalez 2016 - http://www.npr.org/sections/alltechconsidered/2016/01/03/460962121/for-internet-to-go-check-the-library

Greene 2015 - http://content.healthaffairs.org/content/34/3/431.full




About the author:

Kirsten Schultz is a health activist and blogger. You can read more about her life living with multiple chronic illnesses on her blog, on Creaky Joints, or follow her on Twitter.  


She will also be joining us this year at ePharma as an official guest blogger sharing insights from the event.  ePharma will take place February 29 - March 2, 2016, in New York City.  As a reader of this blog, when you register to join us with priority code EPHARMA16BL, you can save $100 off current rates!
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