Applying the Patient Empowerment, Engagement, and Activation Survey to Improve Patient Outcomes. (2024)

Applying the Patient Empowerment, Engagement, and Activation Survey to Improve Patient Outcomes.

Jaynelle F Stichler, Luc R Pelletier

Abstract

This article focuses on applying the patient empowerment, engagement, and activation (PEEA) model as an implementation strategy to achieve patient- or person-centered care. There is substantial evidence linking PEEA to improved patient care outcomes and reduced healthcare costs. Interrelationships among the 3 concepts are discussed and how the PEEA survey can be used to evaluate patients' activation for self-care postdischarge and their perceptions of nurses' empowering and engaging them during the care encounter.

References

1. Pelletier LR, Stichler JF. Action brief: patient engagement and activation: a health reform imperative and improvement opportunity for nursing. Nurs Outlook. 2013;61(1):51–54.
2. Pelletier LR, Stichler JF. Ensuring patient and family engagement: a professional nurse's toolkit. J Nurs Care Qual. 2014;29(2):110–114.
3. Pelletier LR, Stichler JF. Patient-centered care and engagement: nurse leaders' imperative for health reform. J Nurs Adm. 2014;44(9):473–480.
4. Hickmann E, Richter P, Schlieter H. All together now—patient engagement, patient empowerment, and associated terms in personal healthcare. BMC Health Serv Res. 2022;22(1):1116.
5. Greene J, Hibbard JH, Sacks R, Overton V, Parrorra CD. When patient activation levels change, health outcomes and costs change, too. Health Aff (Millwood). 2015;34(3):431–437.
6. Anderson G, Rega ML, Casasanta D, Graffigna G, Damiani G, Barello S. The association between patient activation and healthcare resources utilization: a systematic review and meta-analysis. Public Health. 2022;210:134–141.
7. Jerofke T, Weiss M, Yakusheva O. Patient perceptions of patient-empowering nurse behaviours, patient activation and functional health status in postsurgical patients with life-threatening long-term illnesses. J Adv Nurs. 2014;70(6):1310–1322.
8. Pekonen A, Eloranta S, Stolt M, Virolainen P, Leino-Kilpi H. Measuring patient empowerment—a systematic review. Patient Educ Couns. 2020;103(4):777–787.
9. Hibbard JH, Greene J, Shi Y, Mittler J, Scanlon D. Taking the long view: how well do patient activation scores predict outcomes four years later? Med Care Res Rev. 2015;72(3):324–337.
10. Graffigna G, Barello S, Bonanomi A. The role of patient health engagement model (PHE-model) in affecting patient activation and medication adherence: a structural equation model. PloS One. 2017;12(6):e0179865.
11. Kim JY, Wineinger NE, Steinhubl SR. The influence of wireless self-monitoring program on the relationship between patient activation and health behaviors, medication adherence, and blood pressure levels in hypertensive patients: a substudy of a randomized controlled trial. J Med Internet Res. 2016;18(6):e116.
12. Kinney RL, Lemon SC, Person SD, Pagoto SL, Saczynski JS. The association between patient activation and medication adherence, hospitalization, and emergency room utilization in patients with chronic illnesses: a systematic review. Patient Educ Couns. 2015;98(5):545–552.
13. Magnezi R, Glasser S, Shalev H, Shelber A, Reuveni H. Patient activation, depression and quality of life. Patient Educ Couns. 2014;94(3):432–437.
14. Keen A, Lu Y, Oruche UM, Mazurenko O, Burke Draucker C. Patient activation of persons with opioid use disorder in intensive outpatient treatment. J Am Psychiatr Nurses Assoc. 2022;10783903221096473.
15. Melby K, Nygård M, Brobakken MF, et al. Test-retest reliability of the Patient Activation Measure-13 in adults with substance use disorders and schizophrenia spectrum disorders. Int J Environ Res Public Health. 2021;18(3):1185.
16. Reeves MJ, Fritz MC, Woodward AT, et al. Michigan Stroke Transitions Trial. Circ Cardiovasc Qual Outcomes. 2019;12(7):e005493.
17. Anderson JK, Wallace LM. Evaluation of uptake and effect on patient-reported outcomes of a clinician and patient co-led chronic musculoskeletal pain self-management programme provided by the UK National Health Service. Br J Pain. 2018;12(2):104–112.
18. Rossetto F, Borgnis F, Blasi V, et al. System Integrated Digital Empowerment and Rehabilitation to promote patient Activation and well-Being (SIDERA^ B): protocol for a randomized crossover trial on effectiveness and implementation. medRxiv. 2022. doi:10.1101/2022.04.19.22274012. doi:10.1101/2022.04.19.22274012
19. Shnaigat M, Downie S, Hosseinzadeh H. Effectiveness of patient activation interventions on chronic obstructive pulmonary disease self-management outcomes: a systematic review. Aust J Rural Health. 2022;30(1):8–21.
20. Wetzstein MM, Shanta LL, Chlan LL. Patient activation among community-dwelling persons living with chronic obstructive pulmonary disease. Nurs Res. 2020;69(5):347–357.
21. Dunlay SM, Griffin JM, Redfield MM, Roger VL. Patient activation in acute decompensated heart failure. J Cardiovasc Nurs. 2017;32(6):560–567.
22. Masterson Creber R, Chen T, Wei C, Lee CS. Brief report: patient activation among urban hospitalized patients with heart failure. J Card Fail. 2017;23(11):817–820.
23. Lightfoot CJ, et al. Patient activation: the cornerstone of effective self-management in chronic kidney disease? Kidney Dial. 2022;2(1):91–105.
24. Dumitra T, Ganescu O, Hu R. Association between patient activation and health care utilization after thoracic and abdominal surgery. JAMA Surg. 2021;156(1):e205002.
25. Almutairi N, Hosseinzadeh H, Gopaldasani V. The effectiveness of patient activation intervention on type 2 diabetes mellitus glycemic control and self-management behaviors: a systematic review of RCTs. Prim Care Diabetes. 2020;14(1):12–20.
26. Regeer H, et al. Change is possible: how increased patient activation is associated with favorable changes in well-being, self-management and health outcomes among people with type 2 diabetes mellitus: a prospective longitudinal study. Patient Educ Couns. 2022;105(4):821–827.
27. Charlot M, Winter MR, Cabral H, et al. Patient activation mediates health literacy associated with hospital utilization among Whites. Health Lit Res Pract. 2017;1(3):e128–e135.
28. Catalyst N. Patient Engagement Buzz Survey: PROMs use is growing, but implementation takes effort. NEJM Catalyst. 2019;5(5).
29. Field J, Holmes MM, Newell D. PROMs data: can it be used to make decisions for individual patients? A narrative review. Patient Relat Outcome Meas. 2019;10:233–241.
30. Hudon C, Danish A, Lambert M, et al. Reconciling validity and challenges of patient comfort and understanding: guidelines to patient-oriented questionnaires. Health Expect. 2022;25(5):2147–2154.
31. Kingsley C, Patel S. Patient-reported outcome measures and patient-reported experience measures. BJA Educ. 2017;17(4):137–144.
32. Hibbard JH, Stockard J, Mahoney ER, Tusler M. Development of the Patient Activation Measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Serv Res. 2004;39(4 pt 1):1005–1026.
33. Pelletier LR, Stichler JF. Words matter: scripting to enhance patient engagement. My Am Nurse. 2021;16(11):50–55.
34. Hull SC. Enhancing patient engagement through sharing: sharing stories, health information, and decision making promotes active engagement. Am Nurse Today. 2015;10(5):S6–S6.
35. Shuss S, Lockhart L, Kelton D, Davis C. Patient-centered care pointers. Nurs Made Incred Easy. 2015;13(3):20–27.
36. Tzeng HM, Yin CY, Fitzgerald K. Engaging patients in their care versus obscurantism. Nurs Forum. 2015;50(3):196–200.
37. Biber J, Ose D, Reese J, et al. Patient reported outcomes—experiences with implementation in a university health care setting. J Patient Rep Outcomes. 2018;2:34.
38. Zhang R, Burgess ER, Reddy MC, et al. Provider perspectives on the integration of patient-reported outcomes in an electronic health record. JAMIA Open. 2019;2(1):73–80.
39. Horn ME, Reinke EK, Mather RC, O'Donnell JD, George SZ. Electronic health record-integrated approach for collection of patient-reported outcome measures: a retrospective evaluation. BMC Health Serv Res. 2021;21:626.
40. Gensheimer SG, Wu AW, Snyder CF; PRO-HER User's Guide Steering Group, PRO-HER User's Guide Working Group. Oh, the places we'll go: patient-reported outcomes and electronic health records. Patient. 2018;11:591–598.

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