7. PAM Survey Summary

from TIPs Research Report 2021

6. Financial Sustainability

Patient Activation Measure (PAM) surveys have been conducted periodically between November 2019 through April 2021 with participants in the TIPs program at Grace West Manor and Townhomes. The Patient Activation Measure (PAM) is a well validated instrument measuring health-related confidence, engagement, behaviors, and lifestyle used extensively to establish baseline health engagement and change over time and circumstance.

PAM was initiated in November 2019 with monthly measures taken through March 2020 with quarterly follow-up anticipated. At that point, the COVID-19 crisis imposed serious disruption in both program vital signs monitoring for all 200+ enrolled participants in the program and PAM data gathering for those participating in this measure. PAM surveys were re-established on a limited basis in March 2021. The program “pivots” in services from “TIP Classic” with congregate group services, to “TIPs in Touch” telephone-based services without vital signs monitoring at the outset of COVID-19 restrictions, to “TIPs at Home” with limited participation to selected elderly high-risk participants, was instrumental in maintaining health related activities and services during this time.

The following sections present a summary of two measures of the overall effects of the program, particularly on the four levels of patient activation which the PAM survey measures (Level 1: Disengaged and Overwhelmed; 2: Aware but Struggling; 3: Taking Action/Gaining Control; 4: Maintaining Behaviors and Progress). The overall results include general trends and changes in levels of PAM scores among residents who were consistently participating in the program from initiation through April 2021 and who had completed at least two PAM surveys during that time. The sample included (n=49) is smaller than the number of participants in the program but offers a reasonable framework for assessing the program effects on participant health activation.

7. PAM Survey Report

I. TRENDS

This section presents the overall comparison of PAM baseline results at implementation through contract completion and reflects changes in the initial levels of patient activation with those of the most recent levels.

There has been a noticeable increase in the number of participants in Level 3 (D= +6) and comparable decrease in Level 2 (D= -7). While there is also no significant difference in the baseline average PAM score (58.8) with the program final average score (58.5), individual changes within levels does indicate a relatively dramatic increase in this higher level of health activation.

II. CHANGE WITHIN LEVELS

There is continued observational evidence that the circumstances of the COVID-19 crisis have continued to impact specific items measuring health confidence and behaviors, especially with concerns related to items such as, “I have been able to maintain (keep up with) lifestyle changes, like eating right or exercising.”, “I know how to prevent problems with my health.”, and “I am confident that I can figure out solutions when new problems arise with my health.”, and additionally in more recent surveys , “I am confident that I can maintain lifestyle changes, like eating right and exercising, even during times of stress.” attesting to the impact of Covid 19 stresses and uncertainties on health issues.

The changes within levels observed further illustrates the generally positive effects pattern from participation in the TIPs program, despite the stresses imposed by COVID-19 restrictions on social interaction with friends and family, reduced access to services, and uncertainties about vulnerability and transmission. Noticeable gain scores for Level 1 and Level 2, in this case the average score gains are +6.44 (14%) and +9.65 (19%) respectively with 80% of the group experiencing improved scores. The declines among Level 3 (-11.5%) and Level 4 (-18.3%) are also notable in view of the general stability expected for those groups. While many aspects of the interaction within and between the intervention and health activation scores remain to be examined in depth, there are certainly clear and consistent indicators suggesting considerable improvement in participants embracing a more active role in their health behaviors and attitudes through participation in the telehealth program.