TAKING CHARGE:What is the Relationship Between Patient Activation and Motivational Interviewing? Verna Burden, MS, RD; Laura Blue, MPH; Susan Butterworth, PhD, MS; Ariel Linden, DrPH Developed by Dr. Judy Hibbard and colleagues at the University of Oregon, the Patient Activation Measure (PAM) is a valid, highly reliable Guttman-like scale that reflects a developmental model of activation. (Hibbard et. al, 2004; Hibbard et. al, 2005). The PAM measures the extent to which: 1) patients know how to manage their condition, 2) have the skills and behavioral repertoire to manage their condition, and 3) have the confidence that they can collaborate with their health providers, maintain functioning, and access appropriate and high quality care. Could Patient Activation be an underlying mechanism of how MI works? Self Efficacy and Patient Activation: Self efficacy varies across and within a domain. • Supporting client autonomy to enhance the client’s perception of choice about change Preventative Behaviors Knowledge Consumeristic Behaviors Self-care Behaviors The Patient Activation Measure is comprised of 13 questions categorized under the four domains they are intended to measure. 35-40% of the population • Directing toward the target behavior that the client chooses Various Health Behaviors “Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a life time.” -Chinese Proverb Design: Quasi-experimental study design Four levels of ‘activation’ or self-management competency 20-25% of the population • Evoking to facilitate the client’s discovery of their own path to change • Expressing empathy to value and reinforce the client’s experience and understanding MI-based health coaching shows increase in Patient Activation Confidence 10-15% of the population Patient activation can be influenced, but tends to hold steady across and within a domain. Patient Activation Measure Various Health Behaviors Skills MI spirit and characteristics in light of Patient Activation • Collaborating to identify the client as having knowledge, skill and confidence regarding the change process Self-efficacy What is Patient Activation? 25-30% of the population Several studies have demonstrated the PAM’s ability to effectively measure activation and predict health-related behaviors and outcomes. • A positive change in activation was associated with positive changes in fruit and vegetable consumption, regular exercise and stress management (Hibbard et. al, 2007). • An inverse association between patient activation and length of stay during hospitalization and inpatient admissions after emergency department visits was demonstrated (Hibbard et. al, 2009). • In patients with diabetes, higher PAM scores were associated with improved self-care, medication adherence, higher quality of life, and lower emergency room and hospitalization use (Mosen et. al, 2007). To date, no research has focused on the possible relationship between MI and PAM. Setting: A large medical university in the Northwest United States Method: 106 chronically ill program participants completed a health risk survey instrument prior to enrollment and again at approximately 8 months. Outcomes were compared to 230 chronically ill non-participants who completed the survey twice over a similar time frame. Inverse probability of treatment weights were used in conjunction with the propensity score to correct for selection bias. Results: Compared to non-participants, program participants improved on patient activation (P=0.02), self efficacy (P=0.01), lifestyle change score (P=0.01), and perceived health status (P=0.03). Conclusion: These results support motivational interviewing-based health coaching as an effective chronic care management intervention in impacting outcome measures that could also serve well as a proxy in the absence of other clinical or cost indices. A randomized controlled trial with MI-based health coaching Traditional medical model: Expert treats health condition Patient activation construct: Empowerment of the patient is key give a person a fish teach a person to fish Patient Activation: The degree to which a person is engaged in managing health conditions = The degree to which a person is engaged in fishing Motivational Interviewing: A guiding method of communication to elicit and strengthen motivation to fish Where the rubber meets the road • Three coaching sessions focused on exercise, stress management, diet and tobacco use • At six-month follow up, significant improvement in health behaviors addressed AND in health behaviors not addressed (Prochaska, et. al, 2008). In chronic care management, we suggest that an increase in Patient Activation be the overall target behavior addressed in the coaching interaction. For example, in 2-3 sessions with a person with diabetes, a focus on empowering the client to take action may prove to have a ripple affect into multiple behaviors associated with managing their disease. Hypothesis:MI may facilitate an improvement in Patient Activation which could explain why multiple risk factors changed within a brief intervention. References: Self-management competencies differ significantly by level of activation About Health Management Services The mission of Health Management Services (HMS) at Health Future is to identify and disseminate best practice in health management and chronic care. Located in Portland, Oregon, Health Management Services was founded in 1997 at Oregon Health & Science University. We provide-evidenced based employee interventions designed to reduce health risks, manage chronic disease and increase productivity, focusing on our MI-based health survey and health coaching. Hibbard, J.H., Mahoney, E.R., Stockard, J., Tusler, M. Development and Testing of a Short Form of the Patient Activation Measure. Health Serv Res 2005:40(6): 1918-30. Hibbard, J.H., Mahoney E., Stock R., Tusler M. Unpublished research shared by Judith H. Hibbard in personal communications. November 9, 2009. Hibbard, J.H., Stockard, J., Mahoney, E.R., Tusler, M. Development of the Patient Activation Measure (PAM): Conceptualizing and measuring activation in patients and consumers. Health Serv Res 2004; 39(4):1105-1026. Mosen D, Schmittdiel J, Hibbard JH, Sobel D, Remmers C, Bellows J. Is Patient Activation Associated with Outcomes of Care for Adults with Chronic Conditions? J Ambul Care Manage 2007;30(1):21-29. Prochaska, J.O., Butterworth, S., Redding, C.A., et al. Initial Efficacy of MI, TTM Tailoring and HRI’s with Multiple Behaviors for Employee Health Promotion. Prev Med 2008;46:226-31.