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 trigger 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 :

  • Patient activation and PAM FAQs
  • Patient Activation Measure – Wikipedia

Health and Wellness trends around the world and the emergence of Electronic Health Records(EHR)

Pace of development is increasing across the world thanks to greater innovations that affect every facet of human life. This has great impact on the way people live, work and take care of their health.

As the society is moving more and more into an information driven one, physical work is getting replaced with mental work. This, while reducing the physical exercise that is required to keep our body health, is also increasing our mental stress, causing the emergence of a new phenomenon called lifestyle diseases – diabetes, hypertension, depression, mental stress etc.

With the emergence of increased instances of lifestyle related conditions, modern healthcare is becoming more about managing these conditions and less about treatment of diseases caused by pathogens and infections. Such health condition management is generally of long duration, often lifelong and requires the collection, management and analysis of the person’s lifelong health information and it’s trends.

Many countries across the world have recognized this need for lifelong clinical information of their citizens and have implemented Electronic Health Records (EHR) policies & guidelines. EHR is defined as “A person’s Lifelong Holistic Health History, intended to be used for improvement of the overall health and wellbeing of the person”.

2016 Report of the third global survey on eHealth by World Health Organization(WHO) reports that “There has been steady growth in the adoption of national EHR systems over the past 15 years – and a 46% global increase in the past five years”. Currently the countries with the highest EHR adoption rates are: Norway (98 percent), Netherlands (98 percent), United Kingdom (97 percent), New Zealand (97 percent), Australia (92 percent), Germany (82 percent), United States (69 percent), France (67 percent), Canada (56 percent) and Switzerland (41 percent). EHR adoption is gathering pace and continues to expand around the world.

Indian government has initiated the process of EHR adoption with the publication of its EHR standard in August 2013 and second revision in December 2016. It has also initiated the formation of National e-Health Authority (NEHA), to manage the EHR policies and guidelines for the country.

EHR policies and guidelines are intended to help agencies working on improving overall health and wellness of people. By being EHR compliant, they can ensure that their work complements the other health related activities of the person and provide them lifelong benefit. Further, by systematically managing and analysing the health data generated during their work, the agency can bring in systematic improvement to their programs and make them more effective. Such information also allows them to demonstrate the effectiveness of their work and improve participation.