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www.england.nhs.uk
Person-centred
Care & Patient
Activation
Richard Owen
NHS England
Dr Natalie Armstrong
University of
Leicester
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• In the NHS, what gets measured – gets done.
• Measurement allows us to learn, do things differently
and improve.
• Do we currently measure to support Person-centred
care?
• But, measurement is only one element of
implementing system wide change.
Why measure?
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Patient activation measure (PAM) – is a measurement scale for the knowledge, skill and
confidence a patient has in managing their health and care. The PAM score is based on patients’
responses to 13 questions which include measures of individuals’:
• knowledge (e.g. I understand the nature and causes of my health condition);
• beliefs (e.g. When all is said and done, I am the person who is responsible for managing my
health condition);
• confidence in interacting with healthcare professionals (e.g. I am confident I can tell my health
care provider concerns I have even when he or she does not ask); and
• self-efficacy (e.g. I am confident that I can maintain lifestyle changes like diet and exercise
even during times of stress).
What is Patient Activation?
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PAM Scale
Source: J.Hibbard, University of Oregon
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• PAM has been extensively tested with reviewed findings from over 100 studies that quantified activation. The Kings Fund has published, Supporting people to manage their health – An introduction to patient activation, which introduces the measure, the evidence and its application.
• The evidence shows that more highly activated patients:
o experience better health
o have better outcomes and test results across a number of conditions
o engage in healthier behaviour (correlated to smoking and obesity)
o have fewer episodes of emergency care
What does the evidence say?
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• NHS Horsham and Mid-Sussex CCG & NHS Crawley
CCG
• NHS Islington CCG
• NHS Sheffield CCG
• NHS Somerset CCG
• NHS Tower Hamlets CCG
• UK Renal Registry
The PAM learning-set
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• Lots of evidence about use in the USA
• Little information about how it can improve care and
commissioning in the UK
• We need to find out how to optimise use of the PAM
• Learning from experiences: how it can be used, what
value it has, what are the challenges?
Why evaluate the PAM?
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• Qualitative research – University of Leicester
• Quantitative research – Health Foundation
How will we evaluate?
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• Understand how the PAM is being used in practice
and how its use develops over time
• Determine the impact of using the PAM in
participating organisations
• Explicate the mechanisms of change and contextual
influences on the use of the PAM
• Provide formative feedback to the PAM learning set
• Produce practical evidence for the future; share
knowledge and learning
The evaluation: aims
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• Located within the broad tradition of theory-based
evaluation
• Draws on diverse forms of evidence using multiple
stages of data collection
• Approach permits flexibility to ensure responsive to
changing experiences and remains fit for purpose
• Data collection methods include observation,
interviews and documentary analysis
The evaluation: approach
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• WP1: Surfacing programme theory and understanding
the logic of change as this evolves through time
Focus on ‘core teams’ over project duration
What are they doing, how, why, and how’s it going?
• WP2: Understanding implementation and experiences
at the frontline
Focus on 6 purposively sampled projects
Explore the understanding and use of PAM (and wider
concept of patient activation) in practice
The evaluation: 2 work packages
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• WP1: first round interviews completed, plus 26 hours
of observation at learning set and project-specific
events
• WP2: sample selected and governance procedures
underway
• ‘Early Learning Report’ to be published later this
Summer
The evaluation: progress to date
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• The learning set members are all doing a lot of quite
different things…
• Plans and activities are sometimes changing quite
quickly…
• Timescales are different in all cases…
• Differences in local context, priorities etc
Evaluation approach needs to be able to work with,
and capture, all of this.
Challenges with this type of
evaluation
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• Early Learning Report to be published in the summer
• An interim report by November 2015
• First draft final report by November 2016
• Final draft final report by February 2017
Timeline for evaluation
