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Assessing Patient Activation among High-Need, High-Cost Patients in Urban Safety Net Care Settings

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Abstract

We sought to examine the literature using the Patient Activation Measure (PAM) or the Patient Enablement Instrument (PEI) with high-need, high-cost (HNHC) patients receiving care in urban safety net settings. Urban safety net care management programs serve low-income, racially/ethnically diverse patients living with multiple chronic conditions. Although many care management programs track patient progress with the PAM or the PEI, it is not clear whether the PAM or the PEI is an effective and appropriate tool for HNHC patients receiving care in urban safety net settings in the United States. We searched PubMed, EMBASE, Web of Science, and PsycINFO for articles published between 2004 and 2015 that used the PAM and between 1998 and 2015 that used the PEI. The search was limited to English-language articles conducted in the United States and published in peer-reviewed journals. To assess the utility of the PAM and the PEI in urban safety net care settings, we defined a HNHC patient sample as racially/ethnically diverse, low socioeconomic status (SES), and multimorbid. One hundred fourteen articles used the PAM. All articles using the PEI were conducted outside the U.S. and therefore were excluded. Nine PAM studies (8%) included participants similar to those receiving care in urban safety net settings, three of which were longitudinal. Two of the three longitudinal studies reported positive changes following interventions. Our results indicate that research on patient activation is not commonly conducted on racially and ethnically diverse, low SES, and multimorbid patients; therefore, there are few opportunities to assess the appropriateness of the PAM in such populations. Investigators expressed concerns with the potential unreliability and inappropriate nature of the PAM on multimorbid, older, and low-literacy patients. Thus, the PAM may not be able to accurately assess patient progress among HNHC patients receiving care in urban safety net settings. Assessing progress in the urban safety net care setting requires measures that account for the social and structural challenges and competing demands of HNHC patients.

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Acknowledgements

This research was supported by the National Institutes of Health (NR015233-01). The authors thank the UCSF Education & Copyright Librarians, Peggy Tahir, MLIS, MA and Evans (Whit) Whitaker, MD, MLIS for their assistance with the search methods.

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Authors and Affiliations

  1. Department of Anthropology, History, and Social Medicine, University of California, San Francisco (UCSF), 3333 California Street, Suite 485, San Francisco, CA, 94118, USA

    Tessa M. Napoles & Nancy J. Burke

  2. Public Health, School of Social Sciences, Humanities, & Arts, University of California, Merced, 5200 N Lake Road, Merced, CA, 95343, USA

    Nancy J. Burke

  3. Department of Social and Behavioral Sciences, University of California, San Francisco (UCSF), 3333 California Street, Suite 455, San Francisco, CA, 94118, USA

    Janet K. Shim

  4. Department of Medicine, San Francisco General Hospital, University of California, San Francisco (UCSF), 1001 Potrero Ave, Ward 13, San Francisco, CA, 94110, USA

    Elizabeth Davis

  5. Department of Medicine, Alameda Health System, 1411 East 31st Street, Oakland, CA, 94602, USA

    David Moskowitz

  6. Division of General Internal Medicine, Department of Medicine, University of California, San Francisco (UCSF), 3333 California Street, Suite 335, San Francisco, CA, 94118, USA

    Irene H. Yen

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  1. Tessa M. Napoles
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  2. Nancy J. Burke
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  4. Elizabeth Davis
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Correspondence to Tessa M. Napoles.

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Funding

This work was supported by the National Institutes of Health (NIH NR015233-01).

Additional information

As of May 1, 2017, E. Davis can be reached at the Department of Medicine, Rush University, 1700 W. Van Buren 5th Floor, Chicago IL, 60612. elizabeth_davis@rush.edu.

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Napoles, T.M., Burke, N.J., Shim, J.K. et al. Assessing Patient Activation among High-Need, High-Cost Patients in Urban Safety Net Care Settings. J Urban Health 94, 803–813 (2017). https://doi.org/10.1007/s11524-017-0159-9

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  • DOI: https://doi.org/10.1007/s11524-017-0159-9

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