Gains in Patient Activation (PAM) Scores at 12 Months
The Patient Activation Measure® (PAM®) is a 10 or 13 item questionnaire that assesses an individual´s knowledge, skill and confidence for managing their health and health care. The measure assesses individuals on a 0-100 scale. There are 4 levels of activation, from low (1) to high (4). The measure is not disease specific, but has been successfully used with a wide variety of chronic conditions, as well as with people with no conditions. The performance score would be the change in score from the baseline measurement to follow-up measurement, or the change in activation score over time for the eligible patients associated with the accountable unit. The outcome of interest is the patient’s ability to self-manage. High quality care should result in gains in ability to selfmanage for most chronic disease patients. The outcome measured is a change in activation over time. The change score would indicate a change in the patient´s knowledge, skills, and confidence for selfmanagement. A positive change would mean the patient is gaining in their ability to manage their health.
A “passing” score for eligible patients would be to show an average net 3-point PAM score increase in a 6-12 month period. An “excellent” score for eligible patients would be to show an average net 6-point PAM score increase in a 6-12 month period. An “excellent” score would be for eligible patients to show an average of a 6-point PAM score increase in a 6-12 month period.
ACP does not support NQF 2483 - "Gains in Patient Activation (PAM) Scores at 12 Months" for application at the actual/intended level of analysis: “Group/Practice” because of uncertain validity. There are a number of concerns about the broad applicability of the measure as well as the feasibility and implementation burden the measure would pose. The PMC describe some positives about the design of the measure including looking at a change score and excluding some patients. However, PMC feels that the measure would be better if it applied to a narrower set of patients. Applying to all patients, the measure does not account for patient preference and the instances where a patient may not need activation such as a sore throat or a sprained ankle. This can be burdensome to operationalize and would be very difficult to adopt into a practice that does not already have a robust system to support patient engagement, patient activation and a patient centered experience. It can be difficult for physicians to integrate this into their workflow. In addition, the developers state that PAM scores are higher for people who have good to excellent health. They also acknowledge lower scores for a vast majority of patients that make up an internists patient population (i.e., sicker patients, patients older than 75, the uninsured, Medicaid and Medicare patients). As a result, the performance scores would likely skew lower for internists.