Patient Activation Measure

The Patient Activation Measure (PAM) is a commercial product which assesses an individual's knowledge, skill, and confidence for managing one's health and healthcare. Individuals who measure high on this assessment typically understand the importance of taking a pro-active role in managing their health and have the skills and confidence to do so.

The PAM survey measures patients on a 0–100 scale and can segment patients into one of four activation levels along an empirically derived continuum. Each activation level reveals insight into an array of health-related characteristics, including attitudes, motivators, behaviors, and outcomes.

Development and science

PAM was developed using qualitative methods, Rasch analysis, and classical test theory psychometric methods. Developed by Judith Hibbard and colleagues at the University of Oregon, the resulting 13-item measure is a uni-dimensional, interval level, Guttman-like scale.[1][2] The PAM has strong psychometric properties, and has been translated into 22 different languages.[3] The measure is currently used to assess patient activation or engagement by researchers and clinicians around the world.[4][5][6][7] PAM is offered to healthcare organizations exclusively by Insignia Health, a company based in Portland, Oregon.


Multiple studies show that PAM scores are predictive of most health behaviors, including preventive behaviors (e.g. obtaining screenings and immunizations); healthy behaviors (e.g. healthy diet and regular exercise); self-management behaviors (e.g. monitoring and medication management); and health information seeking.[8][9][10][11][12][13][14][15][16][17][18] Higher activated individuals also have better health outcomes and lower rates of costly utilization, such as emergency department use and hospitalizations.[8][16][17][18][19]

Further there is evidence that with support and appropriate interventions it is possible to increase activation levels in patients.[20][21][22][23][24]

The Patient Activation Measure is being used in a number of ways to improve the delivery of health care, including:

  • a metric to assess the degree to which patients are prepared and able to self-manage
  • to tailor support and education to help patients increase in activation
  • to track the impact of interventions and tailored support on increasing patient activation levels
  • to segment an enrolled patient population, and direct more resources to low activated patients (a more efficient use of resources )
  • to use in population health management
  • to use in predictive modeling, by using both PAM scores and clinical data, it is possible to identify future high risk/high cost patients more accurately than just using clinical data[25]

Use through Insignia Health

Insignia Health holds the worldwide exclusive rights to PAM per a technology transfer from University of Oregon. Insignia licenses PAM and other related products to organizations in the U.S. and abroad. PAM is being used in 16 countries today.


  1. Hibbard, Judith; Stockard, J; Mahoney, ER; Tusler, M (August 2004). "Development of the Patient Activation Measure (PAM): Conceptualizing and measuring activation in patients and consumers". Health Services Research. 39 (4): 1005–10026. doi:10.1111/j.1475-6773.2004.00269.x. PMC 1361049. PMID 15230939.
  2. Hibbard, Judith; Mahoney, Eldon R.; Stockard, Jean; Tusler, Martin (December 2005). "Development and testing of a short form of the patient activation measure". Health Services Research. 40 (6): 1918–1930. doi:10.1111/j.1475-6773.2005.00438.x. PMC 1361231. PMID 16336556.
  3. Hibbard, Judith (27 July 2014). deBronkart, e-Patient Dave, ed. "[Comment on] The Patient Activation Measure (PAM): a framework for developing patient engagement". Society for Participatory Medicine.
  4. Rademakers, Jany; Nijman, Jessica; van der Hoek, Lucas; Heijmans, Monique; Rijken, Mieke (31 July 2012). "Measuring patient activation in the Netherlands: translation and validation of the American short form Patient Activation Measure (PAM13)". BMC Public Health. 12: 577. doi:10.1186/1471-2458-12-577. PMC 3490810. PMID 22849664.
  5. Brenk-Franz, K; Hibbard, JH; Herrmann, WJ; Freund, T; Szecsenyi, J; Djalali, S; Steurer-Stey, C; Sönnichsen, A; Tiesler, F; Storch, M; Schneider, N; Gensichen, J (30 September 2013). "Validation of the German version of the patient activation measure 13 (PAM13-D) in an international multicentre study of primary care patients". PLoS One. 8 (9): e74786. doi:10.1371/journal.pone.0074786. PMC 3787015. PMID 24098669.
  6. Fujita, Emi; Kuno, Eri; Kato, Daiji; Kokochi, Mariko; Uehara, Kumi; Hirayasu, Yoshio (15 August 2010). "精神の健康管理への積極性評価尺度(Patient Activation Measure 13 for Mental Health;PAM13-MH)日本語版の開発" [Development and Validation of the Japanese Version of the Patient Activation Measure 13 for Mental Health]. Seishin Igaku (Clinical Psychiatry) (in Japanese). 52: 765–772. doi:10.11477/mf.1405101678.
  7. Steinsbekk, A (23 October 2008). "Måling av effekt av pasientopplæring" [Patient Activation Measure]. Tidsskrift for den Norske lægeforening (in Norwegian). 128 (20): 2316–2318. PMID 19096487.
  8. 1 2 Greene, Jessica; Hibbard, Judith H. (May 2012). "Why Does Patient Activation Matter? An Examination of the Relationship Between Patient Activation and Health-Related Outcomes". Journal of General Internal Medicine. 27 (5): 520–6. doi:10.1007/s11606-011-1931-2. PMC 3326094. PMID 22127797.
  9. Hibbard, Judith; Mahoney, ER; Stock, R; Tusler, M (August 2007). "Do increases in patient activation result in improved self-management behaviors?". Health Services Research. 42 (4): 1443–1463. doi:10.1111/j.1475-6773.2006.00669.x. PMC 1955271. PMID 17610432.
  10. Fowles, Jinnet Briggs; Terry, Paul; Xi, Min; Hibbard, Judith; Bloom, Christine Taddy; Harvey, Lisa (October 2009). "Measuring self-management of patients' and employees' health: further validation of the Patient Activation Measure (PAM) based on its relation to employee characteristics". Patient Education and Counseling. 77 (1): 116–122. doi:10.1016/j.pec.2009.02.018. PMID 19356881.
  11. Mosen, David M.; Schmittdiel, Julie; Hibbard, Judith; Sobel, David; Remmers, Carol; Bellows, Jim (January–March 2007). "Is patient activation associated with outcomes of care for adults with chronic conditions?". Journal of Ambulatory Care Management. 30 (1): 21–29. doi:10.1097/00004479-200701000-00005. PMID 17170635.
  12. Becker, Edmund R.; Roblin, Douglas W. (August 2008). "Translating primary care practice climate into patient activation: the role of patient trust in physician". Medical Care. 46 (8): 795–805. doi:10.1097/mlr.0b013e31817919c0. PMID 18665059.
  13. Hibbard, Judith; Cunningham, PJ (October 2008). "How engaged are consumers in their health and health care, and why does it matter?". Research Brief. 8: 1–9. PMID 18946947.
  14. Tabrizi, Jafar S.; Wilson, Andrew J.; O'Rourke, Peter K. (18 December 2010). "Customer Quality and Type 2 Diabetes from the Patients' Perspective: A Cross-Sectional Study". Journal of Research in Health Sciences. 10 (2): 69–76. PMID 22911927.
  15. Rask, Kimberly J.; Ziemer, David C.; Kohler, Susan A.; Hawley, Jonathan N.; Arinde, Folakemi J.; Barnes, Catherine S. (July–August 2009). "Patient activation is associated with healthy behaviors and ease in managing diabetes in an indigent populations". Diabetes Education. 35 (4): 622–630. doi:10.1177/0145721709335004. PMID 19419972.
  16. 1 2 Rogvi, S; Tapager, I; Almdal, TP; Schiøtz, ML; Willaing, I (October 2012). "Patient factors and glycaemic control: associations and explanatory power". Diabetic Medicine. 29 (10): e382–9. doi:10.1111/j.1464-5491.2012.03703.x. PMID 22540962.
  17. 1 2 Salyers, Michelle P.; Matthias, Marianne S.; Spann, Crystal L.; Lydick, Jennifer M.; Rollins, Angela L.; Frankel, Richard M. (November 2009). "The role of patient activation in psychiatric visits". Psychiatric Services. 60 (11): 1535–1539. doi:10.1176/ PMC 2777630. PMID 19880475.
  18. 1 2 Remmers, Carol; Hibbard, Judith; Mosen, David M.; Wagenfield, Morton; Hoy, Robert E.; Jones, Ches (October–December 2009). "Is patient activation associated with future health outcomes and healthcare utilization among patients with diabetes?". Journal of Ambulatory Care Management. 32 (4): 320–327. doi:10.1097/jac.0b013e3181ba6e77. PMID 19888008.
  19. Begum, Nelufa; Donald, Maria; Ozolins, Ieva Z.; Dower, Jo (August 2011). "Hospital admissions, emergency department utilisation and patient activation for self-management among people with diabetes". Diabetes Research and Clinical Practice. 93 (2): 260–267. doi:10.1016/j.diabres.2011.05.031. PMID 21684030.
  20. Lorig, K; Ritter, PL; Laurent, DD; Plant, K; Green, M; Jernigan, VB; Case, S (June 2010). "Online Diabetes Self-Management Program: A randomized study". Diabetes Care. 33 (6): 1275–1281. doi:10.2337/dc09-2153. PMC 2875437. PMID 20299481.
  21. Druss, Benjamin G.; Zhao, Liping; von Esenwein, Silke A.; Bona, Joseph R.; Fricks, Larry; Jenkins-Tucker, Sherry; Sterling, Evelina; DiClemente, Ralph; Lorig, Kate (May 2010). "The Health and Recovery Peer (HARP) Program: a peer-led intervention to improve medical self-management for persons with serious mental illness". Schizophrenia Research. 118 (1-3): 264–270. doi:10.1016/j.schres.2010.01.026. PMC 2856811. PMID 20185272.
  22. Terry, Paul E.; Fowles, Jinnet Briggs; Xi, Min; Harvey, Lisa (November–December 2011). "The ACTIVATE study: results from a group-randomized controlled trial comparing a traditional worksite health promotion program with an activated consumer program". American Journal of Health Promotion. 26 (2): e64–73. doi:10.4278/ajhp.091029-quan-348. PMID 22040398.
  23. Shively, MJ; Gardetto, NJ; Kodiath, MF; Kelly, A; Smith, TL; Stepnowsky, C; Maynard, C; Larson, CB (January–February 2013). "Effect of Patient Activation on Self-Management in Patients with Heart Failure". Journal of Cardiovascular Nursing. 28 (1): 20–34. doi:10.1097/JCN.0b013e318239f9f9. PMID 22343209.
  24. Hibbard, Judith H.; Greene, Jessica; Tusler, Martin (15 June 2009). "Improving the outcomes of disease management by tailoring care to the patient's level of activation". American Journal of Managed Care. 15 (6): 353–360. PMID 19514801.
  25. Hibbard, Judith (March 2016). "Adding A Measure Of Patient Self-Management Capability To Risk Assessment Can Improve Prediction Of High Costs". Health Affairs. 35 (3): 489–494. doi:10.1377/hlthaff.2015.1031.
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