Jessica Greene1, Judith H Hibbard2, Carmen Alvarez3, Valerie Overton4. 1. School of Nursing, George Washington University, Washington, DC jessgreene@gwu.edu. 2. ISE Health Policy Group, University of Oregon, Eugene, Oregon. 3. School of Nursing, Department of Community-Public Health, Johns Hopkins University, Baltimore, Maryland. 4. Fairview Medical Group, Minneapolis, Minnesota.
Abstract
PURPOSE: We aimed to identify the strategies used to support patient behavior change by clinicians whose patients had an increase in patient activation. METHODS: This mixed methods study was conducted in collaboration with Fairview Health Services, a Pioneer Accountable Care Organization. We aggregated data on the change in patient activation measure (PAM) score for 7,144 patients to the primary care clinician level. We conducted in-depth interviews with 10 clinicians whose patients' score increases were among the highest and 10 whose patients' score changes were among the lowest. Transcripts of the interviews were analyzed to identify key strategies that differentiated the clinicians whose patients had top PAM change scores. RESULTS: Clinicians whose patients had relatively large activation increases reported using 5 key strategies to support patient behavior change (mean = 3.9 strategies): emphasizing patient ownership; partnering with patients; identifying small steps; scheduling frequent follow-up visits to cheer successes, problem solve, or both; and showing caring and concern for patients. Clinicians whose patients had lesser change in activation were far less likely to describe using these approaches (mean = 1.3 strategies). Most clinicians, regardless of group, reported developing their own approach to support patient behavior change. Those whose patients showed high activation change reported spending more time with patients on counseling and education than did those whose patients showed less improvement in activation. CONCLUSIONS: Clinicians vary in the strategies they use to promote behavior change and in the time spent with patients on such activities. The 5 key strategies used by clinicians with high patient activation change are promising approaches to supporting patient behavior change that should be tested in a larger sample of clinicians to validate their effectiveness.
PURPOSE: We aimed to identify the strategies used to support patient behavior change by clinicians whose patients had an increase in patient activation. METHODS: This mixed methods study was conducted in collaboration with Fairview Health Services, a Pioneer Accountable Care Organization. We aggregated data on the change in patient activation measure (PAM) score for 7,144 patients to the primary care clinician level. We conducted in-depth interviews with 10 clinicians whose patients' score increases were among the highest and 10 whose patients' score changes were among the lowest. Transcripts of the interviews were analyzed to identify key strategies that differentiated the clinicians whose patients had top PAM change scores. RESULTS: Clinicians whose patients had relatively large activation increases reported using 5 key strategies to support patient behavior change (mean = 3.9 strategies): emphasizing patient ownership; partnering with patients; identifying small steps; scheduling frequent follow-up visits to cheer successes, problem solve, or both; and showing caring and concern for patients. Clinicians whose patients had lesser change in activation were far less likely to describe using these approaches (mean = 1.3 strategies). Most clinicians, regardless of group, reported developing their own approach to support patient behavior change. Those whose patients showed high activation change reported spending more time with patients on counseling and education than did those whose patients showed less improvement in activation. CONCLUSIONS: Clinicians vary in the strategies they use to promote behavior change and in the time spent with patients on such activities. The 5 key strategies used by clinicians with high patient activation change are promising approaches to supporting patient behavior change that should be tested in a larger sample of clinicians to validate their effectiveness.
Authors: Paul D Thompson; David Buchner; Ileana L Pina; Gary J Balady; Mark A Williams; Bess H Marcus; Kathy Berra; Steven N Blair; Fernando Costa; Barry Franklin; Gerald F Fletcher; Neil F Gordon; Russell R Pate; Beatriz L Rodriguez; Antronette K Yancey; Nanette K Wenger Journal: Circulation Date: 2003-06-24 Impact factor: 29.690
Authors: Richard L Skolasky; Anica M Maggard; David Li; Lee H Riley; Stephen T Wegener Journal: Arch Phys Med Rehabil Date: 2015-03-28 Impact factor: 3.966
Authors: Karen L Lawson; Yvonne Jonk; Heidi O'Connor; Kirsten Sundgaard Riise; David M Eisenberg; Mary Jo Kreitzer Journal: Glob Adv Health Med Date: 2013-05
Authors: Allison V Schlosser; Samantha Smith; Kakul Joshi; Anna Thornton; Erika S Trapl; Shari Bolen Journal: J Gen Intern Med Date: 2019-09-11 Impact factor: 5.128
Authors: Jennifer K Carroll; Kevin Fiscella; Andrea Cassells; Mechelle R Sanders; Stephen K Williams; Brianna D'Orazio; Tameir Holder; Subrina Farah; Chamanara Khalida; Jonathan N Tobin Journal: J Health Care Poor Underserved Date: 2018
Authors: Douglas W Blayney; Melora K Simon; Beatrice Podtschaske; Scott Ramsey; Margaret Shyu; Craig Lindquist; Arnold Milstein Journal: JAMA Oncol Date: 2018-02-01 Impact factor: 31.777