The Patient Activation Measure (PAM) can help case managers discover how engaged patients are with their care and what types of services and assistance they may need.
Here is how it works:
• Train staff and administer survey. “Our team of nurses, social workers, and medical assistants are trained in administering the survey,” says Heidi Steinhebel, RN, BSN, CCM, CCP, senior associate director of care management at IHA in Ann Arbor, MI. “All patients who are engaged into the care management program have a PAM completed within the first one to two touches,” she says. “This can be during a phone call or a face-to-face visit in the clinic.”
Patients complete subsequent PAM surveys every three months or at the time of closure. “If the patient refuses to complete the PAM assessment, it is offered again during the time the patient is in care management,” she says.
“The initial assessment is considered the patient’s baseline measure,” Steinhebel adds. “The case managers follow up with their patients as frequently as a couple of times a week to monthly. This depends on the patient’s PAM level and the goals they are working on.”
• Determine patient’s engagement level. “When a patient’s PAM score is determined, this becomes their baseline PAM score, which allows the care manager to understand the patient’s engagement level,” Steinhebel explains. “The care manager is then able to select the appropriate CFA [coaching for activation] tools that correspond with the patient’s activation level, coupled with any chronic conditions the patient may have.”
The care manager helps the patient set goals, develop action steps, and provide any supporting resources needed. “They provide patient-centered education and goal-setting to meet the patient where they currently are in their healthcare journey,” she adds.
• Understand the four levels of activation. Each level in the PAM tool pertains to a point score:
- Level 1: “The individual is less engaged; they lack confidence, their knowledge is low, and they are less likely to adhere to change,” Steinhebel says. “Interventions are typically weekly, or more frequently. They are short conversations of five to seven minutes, focused on small steps, encouragement, overcoming barriers, and next steps.”
- Level 2: At this level, the person is struggling and becoming aware. The patient may have some knowledge, but large gaps remain.
“They are willing to set some simple goals, as they recognize they can do more,” Steinhebel explains. “Interventions are typically every one to two weeks and last a bit longer, say seven to 10 minutes. Focus on the status of change and addressing barriers; as simple goals are met, set new ones.”
- Level 3: “These patients are taking action, building self-management skills, are goal-oriented, and strive for best practice behaviors,” Steinhebel says.
The interventions are every two to three weeks, and last about 10 to 15 minutes.
“Focus on what is or is not working, overcome barriers, take next steps, and set new goals,” she adds.
- Level 4: “The patient is maintaining behaviors and pushing forward,” Steinhebel says. “They may struggle in times of stress, but they are likely to seek out knowledge and support.”
These interventions are monthly and last 10 to 15 minutes. They are focused on the areas in which the patient is struggling or seeking information, she explains.
• Choose interventions. Interventions might include:
- changing talk to elicit expectations or goals;
- educating patient about their disease or symptom management;
- discussing lifestyle modifications to improve their health;
- addressing barriers to meeting goals;
- assessing confidence.
It also is important to set appropriate goals based on diagnosis and PAM levels. “For example, a patient who is a Level 1 may need something as simple as setting a goal to buy a glucometer, and a Level 2 may be just to test their blood sugar once a day,” Steinhebel says.
“At IHA, we want to focus our work on patients who are Level 1 and Level 2, as these groups are more likely to struggle with making change,” she adds. “They require knowledge and support to identify their goals and to start to set small, incremental goals, leading to behavioral change.”
This also is the population for which case managers can make the biggest impact, Steinhebel adds.