Achieving real cost containment or quality improvement is difficult unless patients and consumers become more active, informed and engaged, says Dr. Judith Hibbard, the professor of health policy at the University of Oregon and the developer of PAM, the Patient Activation Measure ®. How to acheive this? Tailoring your approach towards your low-activation patients and understanding their needs is one way to monitor and create better patient engagement.
Another way to think about using the measurement is how you tailor information and support to individual patients. We know a lot about people at different levels of activation. They all have different needs. A study we conducted and published looked at the impact of tailoring coaching to the patient’s level of activation. In this study, in the intervention group, the patients were measured and the coaches knew the patient’s level of activation. The control group was coached in the usual way. With this study we were comparing the tailored coaching to regular coaching. We examined claims data, clinical indicators and activation levels over a six-month intervention period.
I am now going to share a general idea of how things were tailored. At the low end of activation, level 1 and 2, the focus was on helping people become more self-aware of their own behaviors and helping them to take small steps — giving them permission not to do their full list of things they are supposed to do but to focus on one thing. At this point, people are not doing the full evidence-based behavior that we want them to do eventually, but they are on their way. They are doing pre-behaviors. If they want to work on a diet, they may work on learning how to read a food label, learning about portion size and possibly at two meals a week, reducing portion size. It is a pre-step to taking full action. At level 3, people are taking full action and at level 4, the emphasis is on any lagging behaviors and on maintenance because that is the challenge for many people &@151; to be able to stay and keep the gains that they have made.
We found that the coaches naturally spent more time with the low-activated patients in the intervention group. They had that information and acted on it, even though it wasn’t part of the study or the intervention. They naturally used their resources more efficiently. Tailored coaching people gained more in activation than in the usual coaching and we also saw improvements in blood pressure and low density lipoprotein (LDL) in the intervention group — better improvements than in the control group. For hemoglobin A1C, they both improved; there was no difference there. We did observe improvements in reductions in hospitalization and ER visits in the intervention group as compared to the control group, and there were no changes in office visits.
This study told us that tailoring does help, and there have been other studies since. We can be better at supporting patients if we understand them and their needs.
Source: Guide to Health Coaching
Guide to Health Coaching lays the groundwork for a health coaching initiative, delivering a comprehensive set of 2013 health coaching benchmarks from 150 companies; an examination of integrated coaching’s toolbox of interventions, and much more.