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Prof. Judith H. Hibbard: The King's Fund Annual Conference

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Professor Judith H. Hibbard, Professor of Health Policy, University of Oregon talks about increasing patient activation to improve outcomes and reduce costs at The King's Fund Annual Conference.

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Prof. Judith H. Hibbard: The King's Fund Annual Conference

  1. 1. Increasing patient activation to improve outcomes and reduce costs<br />Judith H. Hibbard<br />Institute for Policy and Research Innovation<br />University of Oregon<br />
  2. 2. Convergence of two important trends:<br /><ul><li>The need to do better with less
  3. 3. The focus on patient-centered care
  4. 4. Patients are an important resource in health care
  5. 5. We won’t reach quality goals and improved outcomes without patient engagement</li></ul>Measurement is key<br /><ul><li>What matters is what gets measured</li></li></ul><li>There is great variation in patient activation in any population group Measurement would allow us to:<br /><ul><li>know who needs more support
  6. 6. target the types of support and information patients and consumers need
  7. 7. evaluate efforts to increase activation.</li></li></ul><li>Measurement of patient activation <br /><ul><li>Share
  8. 8. key insights
  9. 9. implications
  10. 10. applications to improve care and outcomes.</li></li></ul><li>What does it mean to be activated ? <br />
  11. 11. Patient Activation Measurement (PAM) Difficulty structure of 13 items<br />Measurement Properties<br /><ul><li>Uni-dimensional
  12. 12. Interval Level
  13. 13. Guttman-Like Scale</li></ul>Unidimensional<br />Interval Level<br />Guttman-like<br />
  14. 14. Activation is developmental<br />Source: J.Hibbard, University of Oregon<br />
  15. 15. Activation level is predictive of behaviours<br />Research consistently finds that those who are more activated are:<br />engaged in more preventive behaviours<br />engaged in more healthy behaviours<br />engaged in more disease specific self-management behaviours<br />engaged in more health information-seeking behaviours.<br />
  16. 16. Level of activation is linked with behaviours<br />Source: US National sample 2004<br />
  17. 17. Behaviours in medical encounter by activation level <br />
  18. 18. Insights<br /><ul><li>Use activation level to determine what are realistic ‘next steps’ for individuals to take
  19. 19. Many of the behaviours we are asking of people are only done by those in highest level of activation
  20. 20. When we focus on the more complex and difficult behaviours – we discourage the least activated
  21. 21. Start with behaviours more feasible for patients to take on, increases individual’s opportunity to experience success</li></li></ul><li>When activation changes several behaviours change<br />11 of 18 behavioursshow significant improvement within the Increased Growth Class compared to the Stable Growth Class<br />
  22. 22. Activation can predict utilisationand health outcomes two years into the future for diabetics<br />Carol Remmers. The Relationship Between the Patient Activation Measure, Future Health Outcomes, and Health Care Utilization Among Patients with Diabetes. Kaiser Care Management Institute, PhD Dissertation.<br />Multivariate analysis which controlled for age group, gender, race, comorbidities and number of diabetes-related prescriptions. <br />
  23. 23. Low activation signals problems (and opportunities)<br />14<br />
  24. 24. What specific interventions have been shown to increase activation?<br />Stanford CDSMP (peer support and problem-solving)<br />Worksite programmes – environmental<br />Tailored coaching<br />Clinician support<br />
  25. 25. Using the PAM to improve care<br /><ul><li>Evaluations
  26. 26. Improve efficiencies
  27. 27. Improve efficacy
  28. 28. Population-based approaches
  29. 29. Individual tailored approaches</li></li></ul><li>Tailoring support to activation levels<br />
  30. 30. Tailored coaching study<br /><ul><li>Intervention group coached based on level of activation. Control group was ‘usual care’ coaching (DM company)
  31. 31. Examined changes in claims data, clinical indicators, and activation levels
  32. 32. 6 month intervention period</li></li></ul><li>Tailored coaching can improve adherence and reduce unwarranted utilisation<br /> Clinical Indicators* <br />Medications: intervention group increased adherence<br />to recommended immunizations and drug regimens to a<br />greater degree than the control group. This included getting influenza vaccine.<br />Blood Pressure: Intervention group had a significantly greater drop in diastolic as compared to control group. <br />LDL: Intervention group had a significantly greater reduction in LDL, as compared to the control group. <br />A1c: Both intervention and control showed improvements in A1c. <br />*Using repeated measures, and controlling for baseline measures<br />Hibbard, J, Green, J, Tusler, M. Improving the Outcomes of Disease Management by Tailoring Care to the Patient’s Level of Activation. The American Journal of Managed Care, V.15, 6. June 2009<br />19<br />
  33. 33. Still a lot to learn<br /><ul><li>Researchers all over the world are using the PAM, so new insights and findings are being generated
  34. 34. Testing interventions that increase activation in the clinical setting
  35. 35. Care transitions and reducing hospital re-admissions
  36. 36. Community-based approaches to increasing activation</li></li></ul><li>Patient-centered care<br />means meeting patients where they are <br />providing behavioural support that meets the patient’s needs<br />measurement is key to making progress in this area.<br />

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