Wednesday, March 22, 2017

Person Activation Measure(PAM) - Metrics to improve your ability to maintain overall wellness.

There is growing recognition, across the world, of the urgent need to shift healthcare system from being reactive to becoming proactive, from being focused on curative to driving wellness. Current provider-centric approach is designed with the curative approach and delivers poor customer experience, poor quality and high cost outcomes.

To drive adoption of modern wellness concepts, health services will need to be more effectively integrated around the individual rather than being organised around the provider and delivered in a siloed and fragmented way, unable to meet person’s expectations of quality and result.

To drive change in this way, a new set of metrics is needed to measure success, measures that needs to reach beyond the standard “sickness and repair” metrics and allow us to know how well a person is.

One such metric is the Person Activation Measure(PAM), that measures an individual’s knowledge, skill and confidence for managing his/her overall health and wellbeing. This paper mentions that "PAM has been shown to be a better predictor of health outcomes than known socio-demographic factors such as ethnicity and age. More activated people are more likely to attend screenings, check-ups, and immunizations, to adopt positive behaviours (e.g. diet, substance abuse, and exercise), and have clinical indicators in the normal range (e.g. blood sugar levels (A1c), blood pressure and cholesterol)"

Studies using the PAM have also noted that positive PAM scores are correlated with non-health outcomes. For example, workplace studies highlight a relationship between person activation, job satisfaction and absenteeism. Judith Hibbard notes in her paper “As such, patient activation may be tapping into a concept that goes beyond health”.

Insignia health has classified a person's PAM levels as below
  1. Disengaged and overwhelmed - Individuals are passive and lack confidence. Knowledge is low, goal orientation is weak, and adherence is poor.
  2. Becoming aware, but still struggling - Individuals have some knowledge, but large gaps remain. They believe health is largely out of their control, but can set simple goals.
  3. Taking action - Individuals have the key facts and are building self-management skills. They strive for the best practice behaviors, and are goal-oriented.
  4. Maintaining behaviour and pushing action - Individuals have adopted new behaviors, but may struggle in times of stress or change. Maintaining a healthy lifestyle is a key focus.
It has been shown in the earlier quoted King’s Fund paper by Judith Hibbard that improvements in PAM allow people to become good managers of their own health. Studies of interventions to improve PAM show that persons with the lowest activation scores tend to increase their scores the most, suggesting that effective interventions can help engage even the most disengaged.

Useful links :
  1. Patient activation and PAM FAQs
  2. Patient Activation Measure - Wikipedia

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