Increasing self management of chronic conditions through the use of PAM and MI
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This document discusses using the Patient Activation Measure (PAM) and motivational interviewing (MI) to increase self-management of chronic conditions. It provides information on PAM, which measures patient activation in managing their own health on four levels. MI is used to help patients progress to higher activation levels based on assessing their stage of change. The document includes a case study showing how a patient's PAM level increased from 2 to 3 after developing an action plan, and another where a level 1 patient lost 100 pounds and met surgery goals. It notes that motivation and activation can change with life events, and screening for depression is important as it impacts self-management.
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Increasing self management of chronic conditions through the use of PAM and MI
- 1. Increasing self management of chronic conditions through the use of PAM and MI MaryAnne Lindeblad, BSN, MPH Medicaid Purchasing Administration State of Washington October 6, 2010 MaryAnne Lindeblad 1
- 2. High risk, high cost aged, blind and disabled adults with co-occurring disorders The most complex of the complex Payment is through a per member per month method with actuarially certified rates Program is classified as an Prepaid Ambulatory Health Program with CMS Currently using a 1937A Benchmark Benefit Authority MaryAnne Lindeblad 2 Chronic Care Management in Washington State
- 5. Stages of Change measured through modified Stanford Self-Efficacy tool http://patienteducation.stanford.edu/research/download.htmlMaryAnne Lindeblad 3 Client Readiness is Key to Change
- 7. Insignia Health has proprietary rights
- 8. 13 questions about knowledge and confidence in self management
- 9. Administered at beginning of care management, at regular intervals and at “graduation”
- 10. 4 Levels of ActivationMaryAnne Lindeblad 4 Patient Activation Measure (PAM)
- 11. Insignia Health designed “Coaching for Activation” for use by clients or clinicians in conjunction with PAM Motivational Interviewing is used after Stages of Change are assessed Both rely on client readiness for change and confidence in achieving goals MaryAnne Lindeblad 5 Intervention Techniques
- 13. Focused, directive counseling intended to elicit behavioral change that comes from client’s desire and confidence
- 14. Techniques - open questions, reflective listening, affirming and summarizingMaryAnne Lindeblad 6 Motivational Interviews (MI)
- 15. MaryAnne Lindeblad 7 Comparison of Readiness Levels
- 16. MaryAnne Lindeblad 8 Comparison of PAM Levels and Stages of Change, cont.
- 17. Comparison of PAM Levels and Stages of Change, cont MaryAnne Lindeblad 9
- 18. MaryAnne Lindeblad 10 Impact of Intervention on Activation Level
- 20. Action plan included specific action steps for stress management.
- 21. Activation scores moved from Level 2 to Level 3 as she felt more confident in her ability to manage her own health care.MaryAnne Lindeblad 11 Case Study 1Increased Activation with Coaching
- 22. MaryAnne Lindeblad 12 Distribution of PAM ResponsesWashington Medicaid
- 24. Agreed to participate in CCM in order to get gastric bypass and total knee replacement surgeries.
- 25. Client developed action plans related to goal for the knee and bypass surgery .
- 26. Lost 100 pounds, did not need gastric surgery and doing water aerobics.MaryAnne Lindeblad 13 Case Study 2PAM Level 1 Client Success
- 28. Significant life events such as housing change, hospitalization of self or family/friends, new diagnosis, financial stress can stall or change a person’s ability to self manage.MaryAnne Lindeblad 14 Washington Experiences
- 30. Depression affects person’s ability to self manage. Recommend screening.MaryAnne Lindeblad 15 Washington Experiences
- 31. Maryanne.lindeblad@dshs.wa.gov National Academy of State Health PolicyNASHP, October 6, 2010 MaryAnne Lindeblad 16 Thank You
Notas del editor
- PAM = Patient Activation MeasureMI= Motivational Interviewing
- WA has three different approaches as part of our learning about ways to work with this population:Seattle and is based in a Area Agency on AgingSW WA and is based in a mental health facilityIncludes clients receiving in-home personal care services
- Washington is the first state to use the PAM with Medicaid clients.We are just beginning to see some effects of CCM on client activation- details on later slide
- Coaching for Activation is on the Insignia Health website and can be used by clients as a tutorial or by clinicians for concrete steps in goal setting – related to specific disease condition and level of readinessSeattle area program received intensive training with Susan Butterworth of OHSU and Centers for Health Care Strategies on MI.Training included recorded conversations with feedback from trainers and lots of practice
- Care managers feel MI has been a “breakthrough” technique for working with chronic care management clients.
- Note there are similarities between the two systems for the first levels.
- These next two levels are also essentially the same
- Stages of change has two additional levels:Termination which acknowledges a stage when a person is comfortable with the changes madeRecyle/Relapse - recognizing movement between levels
- N= 78 clientsPAM is administered every 4-6 months.The graph hints that something in the time interval moved about 5% more people into the highest readiness category.
- Specific action steps included trigger identification, problem solving related to the relationship with her daughter, and meeting with the nurse in a safe, neutral setting outside her home.Able to resolve or manage her symptoms with coaching
- Total number of responses = 1381Level 1 is lowest activation-Level 1: May not yet believe that the patient role is important Level 2: Lacks confidence and knowledge to take action Distribution for these chronic care Medicaid clients is heavy in Levels 1 and 2. This is the opposite of what Insignia has seen in the commercially insured population. The Medicaid population reported here are complex clients with more than one chronic condition.
- Action Plan: increase his physical activity, manage his pain, lose weightWith coaching at his activation level, he gained enough confidence to accomplish a lot!