Tailored Coaching Can Control Chronic Disease

June 17, 2009 -- People with chronic health conditions who receive coaching tailored to their level of health activities showed significant improvements in clinical outcomes, and experienced fewer hospitalizations and visits to the emergency room than those coached using traditional methods, according to a study published in the June issue of The American Journal of Managed Care.

 

“We’ve moved away from one size fits all to a tailored patient approach using evidence-based guidelines,” said Chris Delaney, chief executive officer of Insignia Health, which markets a survey used to gauge a person’s health behavior. “This allows coaches to address the competencies that drive the behaviors critical to better health and the more efficient use of healthcare resources.” 

 

The study, led by Judith Hibbard, PhD, and colleagues at the University of Oregon, compared the behaviors of patients receiving standard telephone disease management coaching (DM) with those who received more tailored coaching based on their activation level as part of a program offered by LifeMasters Supported SelfCare, Inc. Activation levels are determined by the patient activation measure, ((PAM), a survey tool developed by Hibbard and colleagues to assess an individual’s knowledge, skills and confidence in playing a role in one’s own health and healthcare.

 

The quasi-experimental research, which was conducted in a real-life DM setting, included an intervention group and a control group of nurse coaches and their patients in geographically separate call centers, which were selected based on the similarity of their nurse coaches’ tenure and years of experience. 

 

The findings show those who received coaching with the PAM experienced a 33% decline in hospital admissions compared to the control group, which remained flat, and a 22% decline in emergency room visits compared with an increase of 20% in the control group. The PAM group also experienced statistically significant improvements in diastolic blood pressure and in LDL cholesterol levels relative to the control group, and increased their adherence to recommended immunization and drug regimens, including the influenza vaccine. 

 

The PAM score intervention group showed fewer hospital stays, which translated into a savings of $145 per person per month for the intervention population. A similar decline was seen in visits to the emergency room among this group, which equates to an $11 per person per month savings.  

 

 The patient activation measure, which is licensed and marketed by Insignia Health, consists of a 10 or 13-question survey that asks people about their beliefs, knowledge, skills and confidence for engaging in a wide range of health behaviors. Based on responses to the survey, each person is assigned an activation score and level.    

 

More than 85 studies have documented the PAM’s ability to effectively measure patient activation and to predict a range of behaviors in wide demographic and socioeconomic variability. Research has shown that higher levels of activation rates correlate with improved self-care behaviors.