Assessing Patient Activation among High-Need, High-Cost Patients in Urban Safety Net Care Settings

Abstract

We sought to examine the literature using the Patient Activation Measure (PAM) or the Patient Enablement Instrument (PEI) with high-need, high-cost (HNHC) patients receiving care in urban safety net settings. Urban safety net care management programs serve low-income, racially/ethnically diverse patients living with multiple chronic conditions. Although many care management programs track patient progress with the PAM or the PEI, it is not clear whether the PAM or the PEI is an effective and appropriate tool for HNHC patients receiving care in urban safety net settings in the United States. We searched PubMed, EMBASE, Web of Science, and PsycINFO for articles published between 2004 and 2015 that used the PAM and between 1998 and 2015 that used the PEI. The search was limited to English-language articles conducted in the United States and published in peer-reviewed journals. To assess the utility of the PAM and the PEI in urban safety net care settings, we defined a HNHC patient sample as racially/ethnically diverse, low socioeconomic status (SES), and multimorbid. One hundred fourteen articles used the PAM. All articles using the PEI were conducted outside the U.S. and therefore were excluded. Nine PAM studies (8%) included participants similar to those receiving care in urban safety net settings, three of which were longitudinal. Two of the three longitudinal studies reported positive changes following interventions. Our results indicate that research on patient activation is not commonly conducted on racially and ethnically diverse, low SES, and multimorbid patients; therefore, there are few opportunities to assess the appropriateness of the PAM in such populations. Investigators expressed concerns with the potential unreliability and inappropriate nature of the PAM on multimorbid, older, and low-literacy patients. Thus, the PAM may not be able to accurately assess patient progress among HNHC patients receiving care in urban safety net settings. Assessing progress in the urban safety net care setting requires measures that account for the social and structural challenges and competing demands of HNHC patients.

Household characteristics of persons with complex care needs in the community: A preliminary study

“…Thus, multidisciplinary approaches and seamless healthcare systems are needed to support them (Napoles et al, 2017). However, little is known about the characteristics of households of persons with complex care needs in community settings (Yoshioka-Maeda, 2019).…”

“…In community settings, various departments of the health and welfare system have supported households of persons with complex care needs because their health issues were too complicated to be managed by only one department. Thus, multidisciplinary approaches and seamless healthcare systems are needed to support them (Napoles et al., 2017). However, little is known about the characteristics of households of persons with complex care needs in community settings (Yoshioka‐Maeda, 2019).…”

Social Literacy: Nurses’ Contribution Toward the Co-Production of Self-Management

“…In over 1,000 hours of observations and hundreds of hours of interviews with patients, providers, nurses, social workers, and health coaches, we have explored a broad range of topics centered around the nature and work of CCM and the myriad ways that work is accomplished. For example, we have analyzed the ways in which health care providers assess patient engagement of those whom the health care system refers to as “super utilizers” of health care, many of whom face complex challenges related to socioeconomic and social marginalization ( Fleming et al, 2017 ); the efficacy and effectiveness of the Patient Activation Measure (PAM) and the Patient Engagement Instrument (PEI) with high-need, high-cost patients receiving care in the urban safety net ( Napoles et al, 2017 ); the contradictions of choice within complex care management programs ( Van Natta et al, 2018 ); and the ways in which trauma is defined and understood by CCM providers in the an urban safety net ( Thompson-Lastad et al, 2017 ). Yet, as central as the role of the RN is to the CCM team, there has been no research to date that explores the ways in which CCM nurses take up, engage with, and operationalize the concept of health literacy or how it guides their role on the CCM team.…”

Characteristics of Departments That Provided Primary Support for Households with Complex Care Needs in the Community: A Preliminary Cross-Sectional Study

“…Despite communities providing traditional healthcare services based on the age and needs of residents, it has been difficult to coordinate each service. Thus, households with complex care needs have faced health inequities such as a lack of the multidisciplinary services these cases often need [ 4 , 5 , 6 ]. Realizing health equity that enables everyone to have an opportunity to reach their best health is crucial for securing social justice and promoting health in the community.…”