The Patient Activation Measure (PAM) is a commercial product which assesses an individual's knowledge, skill, and confidence for managing one's health and healthcare. Individuals who measure high on this assessment typically understand the importance of taking a pro-active role in managing their health and have the skills and confidence to do so.

The PAM survey measures patients on a 0–100 scale and can segment patients into one of four activation levels along an empirically derived continuum. Each activation level reveals insight into an array of health-related characteristics, including attitudes, motivators, behaviors, and outcomes.

Development and science[edit]

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.^[1][2] The PAM has strong psychometric properties, and has been translated into 22 different languages.^[3] The measure is currently used to assess patient activation or engagement by researchers and healthcare organizations around the world.^[4][5][6][7] PAM is licensed exclusively through healthcare technology company Phreesia following the acquisition of its original licensor, Insignia Health, in December 2021.^[8]

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),^[9] the Health Literacy Questionnaire and the Health Confidence Score.^[10]

Research[edit]

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.^{[11][12][13][14][15][16][17][18][19][20][21]} Higher activated individuals also have better health outcomes and lower rates of costly utilization, such as emergency department use and hospitalizations.^{[11][19][20][21][22]}

Further there is evidence that with support and appropriate interventions it is possible to increase activation levels in patients.^{[23][24][25][26][27]} In patients with inflammatory arthritis, patient activation has been shown to be associated with self-efficacy, the illness beliefs about treatment, and health literacy.^[28] 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^[29]

References[edit]