Supporting Consumer Activation Judith H Hibbard Institute for

Supporting Consumer Activation Judith H. Hibbard Institute for Policy and Research Innovation University of Oregon

Roles for Patients and Consumers l Making Informed choices l l Using performance and cost information to choose providers Selecting cost-effective evidenced based treatments Making appropriate choices of plans and coverage Activated Patient l l Self-management Preventive actions Collaborating with providers Vigilant partner in assuring health care safety

Use of Information is key to many of these roles: Three Factors Determine How Well People Understand Information l l l The nature of the information and how it is presented The skill of the user The motivation level of the user

Implications for the Design and Promotion of Health Information l l l Changing user skill level is less feasible Changing the materials to make them easier to use and understand is feasible Changing motivation also feasible

Using comparative quality reports requires consumers to work hard l. Understanding the indicators l. Processing the information l. Determining meaningful differences l. Differential weighting of factors l. Bringing the variables together into a choice

Reports that are designed to reduce the burden on the user are more effective l l l Include only indicators that are understood and considered useful Use symbols that are inherently meaningful. Show all the data on one page. Summarize data and use labels that help to interpret it Order by performance.

What the symbols mean: Fewer mistakes, complications and deaths than expected Average number of mistakes, complications and deaths More mistakes, complications and deaths than expected Regional Hospitals Surgery Non-Surgery Hip/Knee Cardiac Maternity Hospital A Hospital B Hospital C Hospital D Community Hospitals * Surgery Non-Surgery Hip/Knee Cardiac Maternity Hospital F Hospital G Hospital H Hospital I Hospital J Hospital K Hospital L Hospital M * Hospital N Hospital O Hospital P * Hospital Q *

Public reports will be more effective when they are made more evaluable, and when consumers understand the need for them. l l Consumers will be more likely to use them Providers will more likely to be motivated to improve by them

Using information and making choices is only part of the picture: consumers also need to be activated and engaged l l Self-management Preventive actions Collaborating with providers Vigilant partner in assuring health care safety

Domains of Activation Measured …self manage …collaborate with provider prevent declines Has the knowledge to: Has the skills to: Can access emotional supports to: Believes patient is important in: Identified by experts and consumers as a key component Identified only by experts as a key component Identified by experts as a key component and identified by consumers as a secondary component …access appropriate and high quality care

The ability to measure activation is important: l l Like every other area of care--Measurement is first step to improvement For targeting what information/supports patients need For evaluating efforts to increase activation For evaluating the quality of care

Rasch Analysis Created PAM l Has strong measurement properties: l l l Unidimensional Interval level measurement Guttman-like

Patient Activation Measurement (PAM) Difficulty Structure of 13 Items 4 Stages of Activation © 2005 University of Oregon

Is Activation Level Predictive of Behaviors? l In a National Sample we found that those who are more activated: l l Engaged in more preventive behaviors Engaged in more disease specific selfmanagement behaviors Engaged in more health consumeristic behaviors More likely to report their providers support patient self-management

Those with hypertension who engage in selfmanagement behaviors by stage of activation

Engagement in the medical encounter by stage of activation Source: US National sample 2004

Consumeristic Behaviors by PAM Stage KEY: ** p <. 01, *** p <. 001 National survey, n = 1515

Implications l l l Use Activation stage to predict behaviors Use Activation stage to determine what are realistic “next steps” for patients to take Many of the behaviors we are asking of consumers are only done by those in stage 4 of activation– May need to start with behaviors more immediately relevant to personal health

Applications of PAM to Improve Outcomes l Track progress or evaluate efforts l l l Evaluation Quality Improvement tool To tailor care or segment population: Managing individual patients and whole patient populations l l l Triaging: Use resources more effectively by increasing contact with those who most need it Use to segment population and intervene Tailoring individual care plans or messages

Summary l l Improving access to and the presentation of information is only the first step. Information does not equal Knowledge and knowledge does not equal action. Supporting consumer behaviors will require that we go beyond the provision of information to supporting activation. Supporting activation may mean taking a more tailored approach and to begin with where the individual is