Eldon R. Mahoney

Toward a theory of patient and consumer activation

OBJECTIVE The purpose of this study is to begin the process of developing a theory of activation, to inform educational efforts and the design of interventions. Because the experience of positive emotions in daily life, tends to widen the individuals array of behavioral responses and increase their openness to new information, we examine how emotions relate to activation levels. METHODS A web survey was carried out in 2008 with a National sample of respondents between the ages of 25-75. The study achieved a 63% response rate with a final sample size of 843. RESULTS The findings indicate that activation is linked with the experience of positive and negative emotion in daily life. Those low in activation are weighted down by negative affect and negative self-perception. CONCLUSIONS Bringing about change in activation, likely means breaking this cycle of negative self-perception and emotions. PRACTICE IMPLICATIONS Experiencing success can start a positive upward cycle, just like failure produces the opposite. By encouraging small steps toward improving health, ones that are realistic, given the individuals level of activation, it is possible to start that positive cycle. Effective educational efforts should focus on improving self-efficacy and the individuals self-concept as a self-manager.

The development and testing of a measure assessing clinician beliefs about patient self-management

Background  Clinicians have been slow to embrace support for patient self‐management.

Developing a Senior Healthcare Practice Using the Chronic Care Model: Effect on Physical Function and Health-Related Quality of Life

An ambulatory senior health clinic was developed using the chronic care model (CCM), with emphasis on an interdisciplinary team approach. To determine the effect of this care model approach in a nonprofit healthcare system, an observational, longitudinal panel study of community‐dwelling Medicare beneficiaries was performed to examine the effect on physical function and health‐related quality of life (HRQL). Participants in the study were recruited from a community sample of 6,864 eligible Medicare beneficiaries. Informed consent and baseline data were obtained from 1,709 individuals (recruitment response rate=25%) and complete data across 30 months from 1,307 (completion response rate=76%). Participants receiving care in the CCM‐based senior healthcare practice (n=318) were compared with patients of primary care physicians supported by care managers (n=598) and a group without care managers (n=391). Self‐reported data were collected over the telephone to measure physical function and HRQL at baseline and 6, 18, and 30 months. A multiple group mixture growth model was used to analyze physical function and HRQL across the 30 months. Physical function and HRQL mean scores decreased across time in all participants and were moderately correlated at each wave (correlation coefficient=0.74–0.79). Two latent growth classes were identified. In class 1, physical function decreased, and HRQL remained stable across time. In class 2, physical function and HRQL decreased in parallel. Ninety‐seven percent of intervention group patients were in class 1, and 99% of patients in comparison groups 1 and 2 were in class 2. Despite physical function decline, patients in a senior health clinic care model maintained HRQL over time, whereas patients receiving traditional care had physical function and HRQL decline. An interdisciplinary team CCM approach appears to have a positive effect on HRQL in this population.

Patient activation measures in a government homeopathic hospital in India.

The American Patient Activation Measure–22 questionnaire (PAM-22) quantifies the knowledge, skills, and confidence essential to manage own health and health care. It is a central concept in chronic illness care models, but studied sparsely in homeopathic hospitals. PAM-22 was translated into Bengali and a cross-sectional study was undertaken in chronically ill 417 patients visiting the outpatient clinic of Mahesh Bhattacharyya Homeopathic Medical College and Hospital, India. Response rate was 90.41%. Data were analyzed using Rasch rating scale model with Winsteps. Activation score was 54.7 ± 8.04 or 62.13% of maximum score. PAM scores differed significantly by age, education, income, and health status (P < .05). The items had good data quality fit statistics and good range of difficulty. The construct unidimensionality was confirmed by good model fits for Rasch model and principal component analysis of residuals found no meaning structure. The questionnaire showed acceptable psychometrics. Patient activation was moderate and needs to be improved.