Patient Activation Measure Scores Research Articles

Health Extension for Diabetes: Impact of a Community-Based Diabetes Self-Management Support Program on Older Adults' Activation.

The goals of this study were to determine whether completion of a community-based diabetes self-management support (DSMS) program delivered through a university Cooperative Extension network increased Patient Activation Measure (PAM) scores and to examine predictors of improvement in PAM score in individuals participating in the DSMS. The Health Extension for Diabetes (HED) is a 4-month program delivered via a paraprofessional extension agent in partnership with an established diabetes self-management education and support program. The study population included 148 adults (median age 69 years; interquartile range 60-74 years) with diabetes recruited from local community organizations. Data for the analysis were collected before and after participation in the intervention as part of a longitudinal study, using the PAM and Self-Efficacy for Diabetes instruments. Descriptive statistics were gathered, and hypothesis tests and simple and multivariable regression analyses were conducted. The mean PAM score increased by 6.58 points, with a 5-point change considered clinically significant. From pre- to post-intervention, PAM scores significantly decreased for 23 participants, decreased for 6, did not change for 14, increased for 21, and significantly increased for 84. Higher pre-intervention PAM scores, younger age, greater educational attainment, and higher baseline self-efficacy scores were associated with increased post-intervention PAM scores when not controlling for potential covariates. Age was no longer associated with higher PAM scores after controlling for covariates. Community-based DSMS interventions can be effective in generating positive change in individuals' activation. HED provides a feasible and accessible DSMS option that addresses key diabetes self-management components while effectively improving individuals' activation. It is recommended that people living with diabetes attend a DSMS program such as HED to increase their ability to effectively self-manage various components of their chronic condition.

Experiences of patients with multimorbidity with primary care and the association with patient activation: a cross-sectional study in Germany

ObjectivesThis study aimed to explore the association between patient activation and patients’ experience of care among an elderly multimorbid population in Germany.DesignCross-sectional study.SettingPrimary care practices in two German settings.Participants346 patients...

Activating people to partner in health and self-care: use of the Patient Activation Measure.

Summary Patient activation is a behavioural concept and is at the heart of personalised care. It is defined as an individual’s knowledge, skill and confidence for managing their health and health care.Evidence indicates that patient activation scores can predict health behaviour and are closely linked to various clinical outcomes: reduced unnecessary emergency department visits, hospital admissions and re‐admissions. Patients with lower activation levels (25–40% of the population) are less likely to adopt healthy behaviour, and more likely to have poorer clinical outcomes and higher rates of hospitalisation.Effective interventions can improve a patient’s activation level, and positive change in activation equates to positive change in self‐care behaviour. But to improve patient activation, we must first measure it using a robust evidence‐based tool such as the Patient Activation Measure (PAM) survey.Armed with the patient’s PAM score, providers can tailor their care and help patients achieve better self‐care, which can improve outcomes of care and reduce unnecessary health care utilisation.The PAM is also useful for population segmentation and risk stratification — to target interventions and health strategies to meet the needs of patients who are at different points along the activation continuum, to measure the performance of health care systems, and to evaluate the effectiveness of health care interventions.The role of patient activation requires further serious consideration if we are to improve the long‐term health and wellbeing of all Australians. The PAM tool is a feasible and cost‐effective solution for achieving the Quadruple Aim — improving population health, the cost‐efficiency of the health system, and patient and provider experience.

50-OR: Peer Support Improves Health Behaviors in People with Prediabetes

Up to one third of Americans have prediabetes, a condition of elevated glucose levels linked with greater diabetes incidence. Strong evidence shows that peer support is an effective strategy to improve outcomes for people with diabetes; however, no studies have examined whether peer support can be leveraged to improve outcomes in people with prediabetes. The “Using Peer Support To Aid in Prevention and treatment of Prediabetes (UPSTART) ” study is a pragmatic randomized controlled trial at Kaiser Permanente Northern California and the University of Michigan that randomized 351 people with prediabetes (A1c 5.7-6.4; BMI >25 or BMI >23 for Asian patients) from 10/19/2018-3/31/2021 to one of two study arms: a peer support intervention with 1:1 matching of prediabetes patients with coaches trained in motivational interviewing (intervention group) ; or enhanced usual care (control group) . All participants received information on healthy eating, active living, wellness, and diabetes prevention programs. Lifestyle and psychosocial factors were measured via baseline and six-month surveys. In our sample, 2of study patients were female; 1were Black; 147 were White; 31 were Hispanic/Latino; 30 were Asian; 24 were Multiracial or ‘Other’ race. At six months, intervention participants had higher participation in diabetes education and prevention programs (25.2% vs. 11.1%, p=.002) ; higher Patient Activation Measure (PAM) scores (68.9 vs. 65.7 on a 0-100 scale, p=.043) ; greater perceived social support (55.3 vs. 49.6 on a 12-72 scale; p<.001) ; and greater whole grain consumption (19.2 vs. 14.5 days out of 30; p=.024) compared to controls. There were no differences in physical activity, vegetable, fruit, or soda consumption at six months. A peer-support program for people with prediabetes has a positive impact on factors linked to diabetes prevention and better health outcomes. Future research from this study will examine whether the intervention and these improvements are also associated with decreased A1c and weight. Disclosure J.Schmittdiel: None. H.Finertie: None. L.A.Rodriguez: None. T.Thomas: None. P.Sanchez: None. M.Heisler: n/a. Funding National Institutes of Health (R18DK113403)

Factors associated with adherence to remote patient monitoring for early detection of dehydration risk during radiation treatment for head and neck cancer.

6076 Background: Remote patient monitoring (RPM) may improve the early detection and mitigation of cancer treatment-related complications, health-related outcomes and quality of life. RPM’s success may depend, in part, on patients’ adherence to remote monitoring protocols. However, factors that influence adherence to RPM are largely unknown. Daily blood pressure/pulse (BP/P), weight, and electronic patient-reported outcomes (ePROs) were monitored remotely in head and neck cancer (HNC) patients undergoing radiation treatment (RT) to identify dehydration risk. We evaluated potential factors associated with RPM adherence. Methods: During RT (average 6 to 7 weeks), participants were asked to take daily (Monday-Friday) measures of BP/P and weight using Bluetooth-enabled devices and to complete daily ePROs using a mobile tablet application (app). Data were provided to their physicians for daily review. The MD Anderson Symptom Inventory-Head and Neck (MDASI-HN) was completed at baseline and end of RT, and 6-8 weeks post-RT completion. The Patient Activation Measure (PAM) was completed at baseline and 6-8 weeks post-RT completion. A device usability survey measuring perceived usefulness of RPM was completed at the end of RT. Adherence to daily monitoring was recorded objectively. Longitudinal analyses compared the relationship between demographic, clinical, and PRO data and monitoring adherence. Results: Participants (n = 169) were 80% male, 87% White, and 91% married. Overall adherence to monitoring BP/P, weight, and ePROs was 83%, 82% and 74%, respectively. Greater HN-specific symptom severity and interference was associated with decreased adherence to daily monitoring of BP/P, weight, and ePROs (P< 0.021). Higher PAM scores were associated with higher adherence to daily monitoring of BP/P only (p = 0.006). Participants reported modest levels of perceived usefulness of RPM across four categories: symptom management, early problem detection, illness monitoring by healthcare provider, and feeling of security during RT. Only a single item indicating perceived feeling of security was associated with greater adherence to daily monitoring of blood pressure/pulse (p = 0.032) and weight (p = 0.007). Conclusions: A benefit of frequent RPM may be early detection and mitigation of symptoms during RT for HNC, however, increasing symptom burden experienced during treatment may interfere with adherence to daily monitoring. Better adherence may be attributed to patients perceiving a sense of security from daily monitoring and may suggest a potentially important value that patients gain from RPM. Understanding factors that impact patient adherence to RPM may help improve acceptability and clinical utility of RPM in oncology. Clinical trial information: NCT02253238.

A randomised controlled clinical trial to assess the benefits of a telecare tool delivered prior to the initial hearing assessment

Objective To assess the benefits of the Ida Institute’s Why improve my hearing? Telecare Tool used before the initial hearing assessment appointment. Design A prospective, single-blind randomised clinical trial with two arms: (i) Why improve my hearing? Telecare Tool intervention, and (ii) standard care control. Study sample Adults with hearing loss were recruited from two Audiology Services within the United Kingdom’s publicly-funded National Health Service. Of 461 individuals assessed for eligibility, 57 were eligible to participate. Results Measure of Audiologic Rehabilitation Self-efficacy for Hearing Aids (primary outcome) scores did not differ between groups from baseline to post-assessment (Mean change [Δ]= −2.28; 95% confidence interval [CI]= −6.70, 2.15, p= .307) and 10-weeks follow-up (Mean Δ= −2.69; 95% CI= −9.52, 4.15, p = .434). However, Short Form Patient Activation Measure scores significantly improved in the intervention group compared to the control group from baseline to post-assessment (Mean Δ= −6.06, 95% CI= −11.31, −0.82, p = .024, ES= .61) and 10-weeks follow-up (Mean Δ= −9.87, 95% CI= −15.34, −4.40, p = .001, ES= −.97). Conclusions This study demonstrates that while a patient-centred telecare intervention completed before management decisions may not improve an individual’s self-efficacy to manage their hearing loss, it can lead to improvements in readiness.

Challenges of Perceived Self-Management in Lupus.

Systemic lupus erythematosus is a chronic autoimmune disease with varied and unpredictable levels of disease activity. The ability to self-manage lupus is important in controlling disease activity. Our objective was to determine levels of patient activation toward self-management in lupus. We used baseline results from the MyLupusGuide study, which had recruited 541 lupus patients from 10 lupus centers. We used the Patient Activation Measure (PAM), a validated self-reported tool designed to measure activation toward self-management ability, as our primary variable and examined its association with demographic, disease-related, patient-provider communication and psychosocial variables captured in our study protocol. Univariable and multivariable linear regressions were performed using linear mixed models, with a random effect for centers. The mean ± SD age of participants was 50 ± 14 years, 93% were female, 74% were White, and the mean ± SD disease duration was 17 ± 12 years. The mean ± SD PAM score was 61.2 ± 13.5, with 36% of participants scoring in the 2 lower levels, indicating low activation. Variables associated with low activation included being single, having lower physical health status, lower self-reported disease activity, lower self-efficacy, use of more emotional coping and fewer distraction and instrumental coping strategies, and a perceived lack of clarity in patient-doctor communication. Low patient activation was observed in more than one-third of lupus patients, indicating that a large proportion of patients perceived that they are lacking in lupus self-management skills. These results highlight a modifiable gap in perceived self-management ability among patients with lupus.

The relationship between patient activation level and self-care management in elderly patients with chronic illness in the southeastern anatolian region of Turkey

Purpose: High level of patient activation is important for better patient outcomes in chronic illnesses. The purpose of the study was to determine the relationship between patient activation level and self-care management among elderly patients with chronic illness. Materials and methods: This descriptive and relational study was conducted with 503 patients aged 65 and older. "Personal Information Form", "Self-care Management Scale in Chronic Illness" and " Patient Activation Measure" was used to collect data. The Chi-squared test, Mann Whitney U,Kruskal Wallis tests and Spearman correlation test were used to evaluate the data. Results: The mean age of the elderly patients with chronic illness was 75.8±7.6. The mean Patient Activation Measure score was 51.3±14.8, and the mean Self-care Management Scale in Chronic Illness score was 99.1 ±10.7. 46.5% of the participants had a low level of activation. A positive and statistically significant correlation was found between the Patient Activation Measure and Self-care Management scale scores. Conclusion: There was a poor association between patient activation and self-care management in these elderly patients with chronic illness. As the activity of the elderly patients participating in this study increased, their self-care management levels also increased. It is thought that the evaluation of activity and self-care levels in order to improve the health outcomes of elderly patients with chronic diseases is important in terms of determining the interventions that should be applied individually. Keywords: Chronic illness; elderly; patient activation; self-care; self-management

Patient Activation During the First 6 Months After the Start of Stroke Rehabilitation

ObjectiveTo examine patient activation from the start of stroke rehabilitation and its course up until the 6-month follow-up. DesignInception cohort study with a follow-up of 6 months. SettingMultidisciplinary rehabilitation facility. ParticipantsA total of 478 patients (N=478) with stroke who received inpatient or outpatient rehabilitation, with a median age of 63.0 years (interquartile range, 56.0-70.0 years) with 308 (64.2%) being men. The study was completed by 439 patients (91.8%). InterventionsNot applicable. Main Outcome MeasuresPatient activation was measured with the Patient Activation Measure (PAM) (score 0-100, 4 levels, where a higher score and level denotes more patient activation). The PAM was measured at the start of the rehabilitation (baseline) and 3 and 6 months thereafter and was analyzed using the multivariate mixed model analysis. ResultsAt baseline, the mean PAM score was 60.2±14.3, with the number of patients in PAM levels 1, 2, 3, and 4 being 76 (17.8%), 85 (19.9%), 177 (41.4%), and 90 (21.0%), respectively. The multivariate mixed-model analysis demonstrated that the PAM score increased over time (baseline 60.2±14.3 vs 3 months 60.7±14.8 vs 6 months 61.9±18.0; P.007). Between baseline and 6 months, 122 patients (41.4%) remained at the same PAM level, 105 patients (35.6%) increased, and 68 patients (23.1%) decreased. At all time points, >35% of patients were in level 1 or 2. ConclusionsPAM scores increased slightly over time from the start of rehabilitation up to the 6-month follow-up. However, more than one-third of patients remained at low levels (ie, level 1 and 2) of patient activation, which indicates that specific interventions during rehabilitation to increase patient activation might be of value.

N05 Patient involvement in Inflammatory Bowel Disease therapy and disease-related parameters - Is there an association?

Abstract Background Recent studies have demonstrated the importance of involving patients afflicted by a chronic disease in their own medical therapy with respect to disease control, compliance and general quality of life. Patient activation refers to patients’ independence in daily activities, involvement in the therapeutic process and having the knowledge, skills, and confidence to manage their health and health care. This study examined the association between the degree of activation of patients with inflammatory bowel disease (IBD) and its effect on health indices Methods This prospective longitudinal study included patients with Crohn’s Disease (CD) or ulcerative colitis (UC) treated at Sheba Medical Center, Israel. The patients answered questionnaires weekly during a period of 8 months using an application installed on their personal mobile phone. The questionnaires addressed clinical and emotional disease parameters, patient’s sense of disease-control (IBD-control), quality of life (short IBD quality of life questionnaire (S-IBDQ) and patient activation measure (PAM), a 4-level model of health behavior. The lowest level indicates that the patient may not believe his/her role in self-care management is important; the second level indicates that the patient lacks confidence or knowledge to take an active role; the third level indicates that the patient is beginning to be active; and the at highest level, patients actively attempt (even with difficulty) to maintain health management behaviors over time. Demographic and medical information, as well as clinical data were retrieved from the medical records. Results Among 356 IBD patients, 208 (58%) answered all questionnaire items and were included in the study 159 (76%) had CD, and 49 (24%) UC, 116 (56%) women and 92 (44%) men). Median scores of the questionnaires were as follows: PAM -63, IQR- 52.9–70.8; SIBDQ- median 44, interquartile ratio (IQR) 40–75; IBD-control 62.4, IQR- 45.7–82. 2 IBD-control mental health component- 47, IQR- 41.1–53.3). PAM was significantly correlated with questionnaires associated with overall well-being, emotional status and quality of life (SIBDQ -r=0.34 p=0.0001, IBD-control -r=0.24, p=0.004 and PROMIS-mental health component r=0.48, p<.0001). There was no significant correlation between PAM and inflammatory markers (C-reactive protein- r=0.09, fecal calprotectin - r=0.12). Conclusion Intensive weekly mobile-App based monitoring program was feasible and adhered to by most patients. PAM scores correlated significantly with their sense of disease-control and mental health scores. Hence, IBD patients’ involvement in medical therapy increases their self-management, sense of disease-control and emotional well-being.

Impact of Behavioral Interventions on Patient Activation in Adults with Hypertension: A Systematic Review and Meta-Analysis.

Introduction: Behavioral interventions assist patients in maintaining optimal self-management of their health, especially in those at risk of certain conditions. Little is known about the effects of self-management interventions on patient activation in adults with hypertension. Therefore, this systematic review and meta-analysis aimed to evaluate how self-management strategies affect changes in activation levels in adults with hypertension. Methods: We searched online databases: PubMed, CINAHL, and Cochrane Central Register of Controlled Trials for studies published between January 2004 and May 2021. We included randomized controlled trials that assessed the effects of self-management interventions on patient activation in adults with hypertension and reported patient activation using the patient activation measure (PAM). Results: 4 Four studies (N = 1415 participants) met the inclusion criteria. In adults with hypertension, self-management interventions improved patient activation with moderate strength of evidence. A community-based self-management program, motivational interviewing strategies, and home-based patient-activated care were associated with better PAM scores than usual care. Conclusion: Our findings reinforce the need for healthcare providers to incorporate these interventions into primary care to support the adoption of recommended hypertension self-management behaviors. Future studies must focus on tailoring support to the patient’s level of activation in hypertension self-management.

Effect of Values Affirmation on Reducing Racial Differences in Adherence to Hypertension Medication

Stereotype threat, or the fear of confirming a negative stereotype about one's social group, may contribute to racial differences in adherence to medications by decreasing patient activation to manage chronic conditions. To examine whether a values affirmation writing exercise improves medication adherence and whether the effect differs by patient race. The Hypertension and Values trial, a patient-level, blinded randomized clinical trial, compared an intervention and a control writing exercise delivered immediately prior to a clinic appointment. Of 20 777 eligible, self-identified non-Hispanic Black and White patients with uncontrolled hypertension who were taking blood pressure (BP) medications, 3891 were approached and 960 enrolled. Block randomization by self-identified race ensured balanced randomization. Patients enrolled between February 1, 2017, and December 31, 2019, at 11 US safety-net and community primary care clinics, with outcomes assessed at 3 and 6 months. Analysis was performed on an intention-to-treat basis. From a list of 11 values, intervention patients wrote about their most important values and control patients wrote about their least important values. The primary outcome of adherence to BP medications was measured using pharmacy fill data (proportion of days covered >90%) at baseline, 3 months, and 6 months. The secondary outcome was systolic and diastolic BP. Patient activation to manage their health was also measured. Of 960 patients, 474 (286 women [60.3%]; 256 Black patients [54.0%]; mean [SD] age, 63.4 [11.9] years) were randomly assigned to the intervention group and 486 (288 women [59.3%]; 272 Black patients [56.0%]; mean [SD] age, 62.8 [12.0] years) to the control group. Baseline medication adherence was lower (318 of 482 [66.0%] vs 331 of 412 [80.3%]) and mean (SE) BP higher among Black patients compared with White patients (systolic BP, 140.6 [18.5] vs 137.3 [17.8] mm Hg; diastolic BP, 83.9 [12.6] vs 79.7 [11.3] mm Hg). Compared with baseline, pharmacy fill adherence did not differ between intervention and control groups at 3 months (odds ratio [OR], 0.91 [95% CI, 0.57-1.43]) or at 6 months (OR, 0.86 [95% CI, 0.53-1.38]). There were also no treatment effect differences in pharmacy fill adherence by patient race (Black patients at 3 months: OR, 1.08 [95% CI, 0.61-1.92]; at 6 months: OR, 1.04 [95% CI, 0.58-1.87]; White patients at 3 months: OR, 0.68 [95% CI, 0.33-1.44]; at 6 months: OR, 0.55 [95% CI, 0.24-1.27]). Immediately after the intervention, the median patient activation was higher in intervention patients than in control patients, but this difference was not statistically significant in an unadjusted comparison (75.0 [IQR, 65.5-84.8] vs 72.5 [IQR, 63.1-80.9]; P = .06). In adjusted models, the Patient Activation Measure score immediately after the intervention was significantly higher in the intervention patients than in control patients (mean difference, 2.3 [95% CI, 0.1-4.5]). A values affirmation intervention was associated with higher patient activation overall but did not improve adherence or blood pressure among Black and White patients with hypertension. ClinicalTrials.gov Identifier: NCT03028597.

Changes in patient activation following cardiac rehabilitation using the Active+me digital healthcare platform during the COVID-19 pandemic: a cohort evaluation

BackgroundRestrictions on face-to-face contact, due to COVID-19, led to a rapid adoption of technology to remotely deliver cardiac rehabilitation (CR). Some technologies, including Active+me, were used without knowing their benefits. We assessed changes in patient activation measure (PAM) in patients participating in routine CR, using Active+me. We also investigated changes in PAM among low, moderate, and high risk patients, changes in cardiovascular risk factors, and explored patient and healthcare professional experiences of using Active+me.MethodsPatients received standard CR education and an exercise prescription. Active+me was used to monitor patient health, progress towards goals, and provide additional lifestyle support. Patients accessed Active+me through a smart-device application which synchronised to telemetry enabled scales, blood pressure monitors, pulse oximeter, and activity trackers. Changes in PAM score following CR were calculated. Sub-group analysis was conducted on patients at high, moderate, and low risk of exercise induced cardiovascular events. Qualitative interviews explored the acceptability of Active+me.ResultsForty-six patients were recruited (Age: 60.4 ± 10.9 years; BMI: 27.9 ± 5.0 kg.m2; 78.3% male). PAM scores increased from 65.5 (range: 51.0 to 100.0) to 70.2 (range: 40.7 to 100.0; P = 0.039). PAM scores of high risk patients increased from 61.9 (range: 53.0 to 91.0) to 75.0 (range: 58.1 to 100.0; P = 0.044). The PAM scores of moderate and low risk patients did not change. Resting systolic blood pressure decreased from 125 mmHg (95% CI: 120 to 130 mmHg) to 119 mmHg (95% CI: 115 to 122 mmHg; P = 0.023) and waist circumference measurements decreased from 92.8 cm (95% CI: 82.6 to 102.9 cm) to 85.3 cm (95% CI 79.1 to 96.2 cm; P = 0.026). Self-reported physical activity levels increased from 1557.5 MET-minutes (range: 245.0 to 5355.0 MET-minutes) to 3363.2 MET-minutes (range: 105.0 to 12,360.0 MET-minutes; P < 0.001). Active+me was acceptable to patients and healthcare professionals.ConclusionParticipation in standard CR, with Active+me, is associated with increased patient skill, knowledge, and confidence to manage their condition. Active+me may be an appropriate platform to support CR delivery when patients cannot be seen face-to-face.Trial registrationAs this was not a clinical trial, the study was not registered in a trial registry.

Factors associated with patient activation in inflammatory arthritis: a multisite cross-sectional study.

ObjectivesPatient activation covers the skills, abilities and behaviour that impact how able and willing someone is to take an active role in self-managing their health. This study explored clinical and psychosocial factors associated with patient activation in rheumatology patients.MethodsThis was a cross-sectional study using postal survey methods. Participants with inflammatory rheumatic conditions were from six rheumatology centres in England. Patient activation was captured using the Patient Activation Measure (PAM). Twenty-nine explanatory factors were tested for potential association with patient activation in univariable and multivariable analyses. In preliminary multivariable analyses, factors found to have an association with patient activation at a P < 0.1 level were entered into the final multivariable model. Those that remained significant at a P < 0.05 level were considered associated with patient activation.ResultsThe sample comprised 251 participants (74% female) with a mean age of 59.31 years (s.d. 12.69), disease duration of 14.48 years (s.d. 12.52) and a PAM score of 58.3 (s.d. 11.46). Of the 29 candidate factors, 25 were entered into a preliminary multivariable analysis. In the final multivariable analysis, four factors (self-efficacy, the illness belief that treatment will control participants’ condition and two dimensions of health literacy) were significantly associated with patient activation. This final model accounted for 40.4% of the variance in PAM scores [F(4, 246) = 41.66, P < 0.001].ConclusionsPatient activation is important in managing rheumatic conditions. Our data confirm that self-efficacy and health literacy are particular targets for patient activation interventions.

A randomized controlled trial of the effect of a community-based intervention on patient activation, health-related quality of life, and acute care use.

1 Background: Low-income and minority populations have disproportionately less activation in their cancer care, worse health-related quality of life (HrQOL), and greater acute care use than affluent and white populations. Community-based interventions are needed to improve patient experiences and quality of cancer care among these populations. We used community-based participatory methods to refine a previously tested intervention for use in Atlantic City NJ. The intervention, LEAPS, uses community health workers trained to activate patients to discuss advance care planning and their symptom burden with cancer clinicians and to connect patients with culturally-relevant community resources to overcome complications from social determinants of health. We conducted a randomized controlled trial of LEAPS in collaboration with a employer-union health fund. Members of the employer-union health fund with newly diagnosed with hematologic and solid tumor cancers were randomized to the 6-month intervention or to usual care. The objective was to determine if the intervention improved HrQOL at 4 months post-enrollment as compared to baseline more than usual care and secondarily the effect on change in patient activation at 4 months post-enrollment as compared to baseline and acute care use within 12 months post-enrollment. Methods: We conducted patient interviews to assess HrQOL and patient activation and obtained claims data for health care use. We used regression models to evaluate differences in health-related quality of life (validated Functional Assessment of Cancer Therapy-General) scores and patient activation (validated Patient Activation Measure) scores between groups over time and exact poisson regression adjusted for length of follow-up to compare emergency department and hospitalization utilization. Results: A total of 160 patients were consented and randomized into the study (80 intervention; 80 control). There were no differences in demographic or clinical factors across groups. The majority were non-white (74%), female (53%), mean age 57 years. The most common diagnoses were breast (31%) and lung (21%) cancer and the majority were diagnosed with stage 3 or 4 (63%). At 4 months, the intervention group had greater improvements in quality of life as compared to the control group (difference in difference: 9.56 p &lt; 0.001), greater change in patient activation (difference in difference: 12.43 (p &lt; 0.001)), and lower acute care use (hospital visits (1.10 (1.53) +/- 1.83 (1.31), p = 0.02) and emergency department use (1.2 (2.82) versus 3.47 (3.62) p = 0.03). Conclusions: Integration of community-based interventions into cancer care for low-income and minority populations may be a more effective and sustainable way to ensure equitable cancer care. Clinical trial information: NCT03699748.

Effect of Posting on Social Media on Systolic Blood Pressure and Management of Hypertension: A Randomized Controlled Trial.

BackgroundOnline platforms are used to manage aspects of our lives including health outside clinical settings. Little is known about the effectiveness of using online platforms to manage hypertension. We assessed effects of tweeting/retweeting cardiovascular health content by individuals with poorly controlled hypertension on systolic blood pressure (SBP) and patient activation.Methods and ResultsWe conducted this 2‐arm randomized controlled trial. Eligibility included diagnosis of hypertension; SBP >140 mm Hg; and an existing Twitter account or willingness to create one to follow study Twitter account. Intervention arm was asked to tweet/retweet health content 2×/week using a specific hashtag for study duration (6 months). The main measures include primary outcome change in SBP; secondary outcome point change in Patient Activation Measure (PAM). We remotely recruited and enrolled 611 participants, mean age 52 (SD, 11.7). Mean baseline SBP for the intervention group was 155.8 and for control was 155.6. At 6 months, mean SBP for intervention group was 137.6 and for control was 135.7. Mean change in SBP from baseline to 6 months for the intervention group was −18.5 and for control was −19.8 (P=0.48). Mean PAM at baseline for the intervention group was 70.3 for control was 72.7. At 6 months, mean PAM scores were 71.1 (intervention) and 75.6 (control). Mean change in PAM score for the intervention group was 0.0 and for control was 3.3 (P=0.12).ConclusionsRecruiting and engaging patients and collecting outcome measures remotely are feasible using Twitter. Encouraging patients with poorly controlled hypertension to tweet or retweet health content on Twitter did not improve SBP or PAM score at 6 months.RegistrationURL: https://www.clinicaltrials.gov. Unique identifier: NCT02622256.

Patient Activation for Self-Management in Patients with Idiopathic Pulmonary Fibrosis or Sarcoidosis

Background: Self-management is considered important in the management of patients with idiopathic pulmonary fibrosis (IPF) or sarcoidosis. However, data about the degree of activation for self-management is lacking. Objectives: The aim of the study was to determine the degree of activation for self-management in patients with IPF or sarcoidosis using the Patient Activation Measure (PAM) and to evaluate the association between PAM scores, clinical characteristics, and health-related outcomes. Study Design and Methods: This cross-sectional prospective study assessed besides the PAM also demographics, lung function, dyspnea (modified Medical Research Council [mMRC]), fatigue (Checklist Individual Strength-Fatigue [CIS-Fatigue]), anxiety/depression (Hospital Anxiety and Depression Scale [HADS-A/HADS-D]), and generic health status (EuroQol five-dimensional-five-level [EQ-5D-5L]). Results: Mean PAM was 55.0 (9.1) points in patients with IPF (n = 59) and low levels of patient activation for self-management (PAM ≤55.1 points) were present in 56% of the patients. PAM Scores correlated significantly (p < 0.05) with mMRC (ρ = −0.476), HADS-A (ρ = −0.326), HADS-D (ρ = −0.459), and EQ-5D-5L (ρ = 0.393). In patients with sarcoidosis (n = 59), the mean PAM score was 55.7 (11.0) points, and 46% of the patients reported low PAM levels. Significant correlations were found with mMRC (ρ = -0.356), HADS-A (ρ = −0.394), HADS-D (ρ = −0.478), and EQ-5D-5L (ρ = 0.313). Conclusion: About half of the outpatients with IPF or sarcoidosis have a low degree of activation for self-management, and these patients generally report more dyspnea, anxiety, depression, and a lower health status. Whether patients with a low degree of activation can be successful in self-managing their disease remains to be determined.

The Care-coordination Approach to Learning Lupus Self-Management: a patient navigator intervention for systemic lupus inpatients

ObjectiveThe Care-coordination Approach to Learning Lupus Self-Management (CALLS) study was designed to improve SLE disease self-management. This study aims to assess the benefits of the intervention compared with existing lupus...

Engaging Patients in the Use of Real-Time Electronic Clinical Data to Improve the Safety and Reliability of Their Own Care.

There is considerable evidence that providing patients with access to their health information is beneficial, but there is limited evidence regarding the effect of providing real-time patient safety-related information on health outcomes. The aim of this study was to evaluate the association between use of an electronic patient safety dashboard (Safety Advisor) and health outcomes. The Safety Advisor was implemented in 6 adult medicine units at one hospital in the United States. Study participants were asked to use the Safety Advisor, which provides real-time patient safety-related information through a Web-based portal. The primary outcome was the association between the application usage and health outcomes (readmission rate and mortality rate) per 3 different usage groups, and the secondary outcome was the association of Patient Activation Measure (PAM) scores with use. One hundred eighty-one participants were included for the data analysis. Approximately 90% of users accessed the application during the first 4 days of enrollment: 51.6% of users only accessed it on 1 day, whereas 5.8% used it more than 3 days. Patients who used the application more had lower 30-day readmission rates (P = 0.01) compared with the lower-usage group. The PAM scores for users of Safety Advisor (71.8) were higher than the nonpatient portal users (60.8, P < 0.0001). We found an association between the use of Safety Advisor and health outcomes. Differences in PAM scores between groups were statistically significant. A larger-scale randomized control trial is warranted to evaluate the impact on patient outcomes among a high-risk patient population.

Examining the Impact of a Peer-Led Group Program for Veteran Engagement and Well-Being.

Objectives: Veterans often suffer from multiple chronic illnesses, including mental health disorders, diabetes, obesity, and cardiovascular disease. The improvement of engagement in their own health care is critical for enhanced well-being and overall health. Peer-led group programs may be an important tool to provide support and skill development. We conducted a pilot study to explore the impact of a peer-led group-based program that teaches Veterans to become empowered to engage in their own health and well-being through mindful awareness practices, self-care strategies, and setting life goals. Design: Surveys were collected before and immediately after participation in the Taking Charge of My Life and Health (TCMLH) peer-led group program. Settings/location: Sessions were held in non-clinical settings within a VA medical center in the Midwest. Subjects: Our sample comprised 48 Veteran participants who were enrolled in TCMLH and completed a pretest and post-test survey. Intervention: TCMLH is a 9-week peer-led group program with an established curriculum that leverages the power of peer support to improve patient engagement, empowerment, health, and well-being among Veterans through Whole Health concepts, tools, and strategies. Programs were led by 1 of 12 trained Veteran peer facilitators. Outcome measures: Program impact on Veteran well-being was assessed by pre-post measures, including the Patient Activation Measure (PAM), the Perceived Stress Scale (PSS), the Patient-Reported Outcomes Measurement Information System Scale (PROMIS-10), the Perceived Health Competency Scale (PHCS), and the Life Engagement Test (LET). Results: There was a significant decrease in perceived stress (PSS score). Significant improvements were also seen in mental health and quality of life (PROMIS-10), participant accordance with the statement "I have a lot of reasons for living" (LET), and patient engagement (PAM score). Conclusions: As the Whole Health movement expands-both in VA and elsewhere-our findings suggest that guiding patients in an exploration of their personal values and life goals can help in key areas of patient engagement and mental and physical health outcomes. Further study is warranted, and expansion of the TCMLH program will allow for a more rigorous evaluation with a larger sample size.