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Meeting the Challenge of Patient Engagement

   August 26, 2015

Judith Hibbard, DrPH

Judith Hibbard, DrPH, is professor emerita in the department of planning, public policy, and management at the University of Oregon, and serves on the leadership team of Insignia Health as the lead researcher and developer of the Patient Activation Measure. PAM is a 10- or 13-question survey a patient takes to assess his or her knowledge, skills, and confidence in managing his or her health. The results of the questionnaire assess patients on a 0–100 scale and can be used to categorize them as a 1, 2, 3, or 4, with 1 representing the lowest activation level and 4 representing the highest.

According to the description of what PAM 1 means, a patient at this level is likely to feel "disengaged and overwhelmed." As the levels increase, so does a patient's confidence. At a PAM level 2, patients are "becoming aware, but still struggling." At a PAM level 3, patients are actively taking a role in the management of their health, and a PAM level 4 patient has made and kept healthier habits. Hibbard has been studying patient activation for 10 years, and has published many peer-reviewed studies that repeatedly show a patient's activation level is related to health outcomes.

"Patients who are less activated are twice as likely to have a 30-day readmission," says Hibbard. "If you look at a commercially insured population, about 30% are in the bottom two levels of PAM; in the Medicare population, 40% are in the bottom two activation levels; and in the Medicaid population, 50% are in the bottom two categories. Becoming activated is possible for everyone."

Time is a critical element to engaging patients. Whether it is encouraging staff to spend more time with patients to get them engaged, as Schaffrinna suggests, or giving patients more time to become active in their own care, Hibbard says that model of care for which most physicians have been educated and trained does not encourage true patient engagement.

"Most physicians are trained to give patients information, and if the patient doesn't follow through, that's not the doctor's problem," she says. "That model doesn't work. In healthcare, we often ask people to do things that are way beyond their capabilities. People want to have good health, but for some, their motivation is muted because they are overwhelmed and discouraged."

Jacqueline Fellows is a contributing writer at HealthLeaders Media.

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