According to an article published in the Wall Street Journal on March 31, 2014, patient outcomes can be impacted by how engaged they are in their care. In this article, How Doctors Rate Patients, studies show that patient outcomes are better—and costs are lower for patients who are actively involved in their care. So why aren’t more patients getting actively involved? Because most patients lack the skills and the confidence to be this kind of patient – and because most healthcare providers haven’t yet recognized this unique way to improve patient engagement and outcomes.
Patient Activation Counts
Patient engagement is becoming a scale upon which patients are rated for their level of “Activation.” Patient activation, described as the measure of how engaged patients are in their care, run from little to no activation, to highly activated.
Highly activated patients are those who show better outcomes and incur lower costs. The problem, however, is that roughly 40% of Americans lack the skills, knowledge and confidence to become fully activated patients. In this group of patients, it is more common to see non-compliance issues like failing to take their medications, skipping preventive screenings and patients who end up back in the hospital soon after discharge.
Encouraging higher levels of patient activation is especially important for patients trying to manage diabetes, high blood pressure or other chronic health conditions, like chronic kidney disease (CKD).
The value of patient activation has translated into benefits for hospitals, healthcare plans and employers who are now beginning to score individuals on how engaged they will be in their care. This process can be accomplished using an assessment tool called the Patient Activation Measure, or PAM.
Patient Rating System Reveals More
PAM scores patient engagement from a level of 0 to 100 by rating 13 statements, such as “I am confident that I can tell a doctor my concerns, even when he or she does not ask.” The results are categorized into one of four activation levels. Patients whose scores rate at level 1, the lowest level, lack confidence and problem-solving ability. Level two is for patients who just starting to build their confidence, whereas level three is for patients who are beginning to use their knowledge and confidence to take action. The highest level, level four, are patients who have transformed their passive habits into proactive behaviors and are pushing forward, despite the fact that they may still struggle in times of overwhelm.
Communication, Communication, Communication
A key benefit to this novel scoring process is that it allows healthcare providers to tailor their communications accordingly, so patients feel empowered rather than overwhelmed. Personalizing patient communications encourages patient confidence, diagnosis ownership and the desire to proactively secure the best outcome.
The PAM evaluation process and reflective scores also help patients recognize the need to improve communication with their doctors. Likewise, it helps care providers become more mindful of the need to encourage patient engagement.
This interactive assessment model also underscores the need for patient empowerment and self-advocacy training, group mentoring/coaching and further investigation of interventional tools that improve patient education and resulting outcomes.
Engagement Supports Patient Compliance, Decline in Hospitalizations & Savings
According to Insignia Health’s Chief Executive Chris Delaney, a single point increase in a PAM score can result in a 2% improvement in medication adherence and a 2% decline in hospitalization, with a reported savings ranging from $260 to $3,700, per patient on an annualized basis. Other improvements reported include a 42% decline in average quarterly emergency and urgent-care visits over 18 months at a primary care practice that used the PAM scoring test in Eugene, Oregon.
“Everyone assumes this is sort of a soft science, but we can measure patient activation just as rigorously and scientifically as other things in health care,” – Judith Hibbard, a senior researcher at the University of Oregon’s Health Policy Research Group and lead developer of the PAM assessment.
To learn more visit: www.transplantfirst.org
Many kidney disease patients are floating in a sea of uncertainty due to inadequate patient education and various knowledge barriers. Consequently, the patient’s understanding of various treatment options and outcomes—and how the timing of engagement can impact each outcome, is often lost in the shuffle of care. With the clock ticking behind the scenes, the patient’s inability to trigger optimal timing for best outcomes remains far beyond the scope of their awareness and comprehension. 
Are you monitoring your blood pressure, weight and lab results closely, or are you relying on your doctors to translate those hard to pronounce words and jumbled corresponding values? Don’t assume you’re being told everything you need to know. You’re the patient and you need to take some responsibility here too by asking key questions and encouraging a dialogue. Your numbers play a significant role in the progression of your disease. They also alert you to a potential problem that you might not be aware of and that you might be able to reverse before the problem worsens.
If you are just showing up for your appointments without a pen and a legal pad full of questions, list of concerns—and your spreadsheets with all your number comparisons, you’re missing out on a valuable wisdom-gaining experience. When you choose to engage, you’ll influence the focus of each appointment from the moment your doctor walks through the door.
If you’re waiting to get sicker before you get serious about your future, you could be in for a rude awaking. Open your eyes to what someday could be the inevitable. Look at it this way, “It’s not a matter of if you’ll ever develop renal failure, it’s a matter of experiencing failure of a different kind. Failure to do something (i.e.; seize opportunity) while you still can.”
The Chinese symbol for crisis combines figures depicting both danger and opportunity. We can learn from this by embracing each precarious situation as an opportunity to discover a better path.
Most CKD patients rarely pick transplant as their first choice, mostly because they are unaware of this opportunity and its unparalleled value. Perhaps you thought dialysis was required before you’d be considered for a transplant. This misconception can keep superior choices beyond your reach.
Are you and your kidney disease hiding in the closet? If so, you’re not alone. I didn’t tell a sole about my condition for years. But then I realized I was doing myself and others a disservice. It takes a village to increase awareness. Your story can touch listeners heartstrings—particularly when it is shared from your heart and when you expect nothing in return. Listeners not only need to learn about your situation, but they also need to know the frightening realities, like the nearly 97,000 people waiting for a kidney transplant, our national organ shortage and it’s catastrophic wait for deceased organs. No doubt your story will elicit curiosity to learn more—and perhaps even do more.