But providers can't always plan care interventions on a case-by-case basis—it can be time-consuming and expensive to customise care for each individual patient, which makes it unrealistic and unsustainable to do at scale.
However, one organisation in the United States overcame that challenge by creating a standardised approach to tailor care to different patient needs. Here's how.
A self-management approach designed to meet patients where they are
VA San Diego Healthcare System in the United States implemented a strategy to improve heart failure patients' self-management abilities over time. The strategy has two key components:
- A consistent method to assess each patient's starting point
- A standardised care pathway tailored to each starting point
VA San Diego uses the Patient Activation Measure, or PAM—a 13-question survey that categorises patients into one of four 'activation' levels based on their knowledge, skills, and confidence in managing their own health and health care.
Patients with a low PAM score of 1 are typically disengaged and overwhelmed, while those at activation level 4 are more successful at maintaining new behaviours and consider themselves owners of their health and care. Higher activation levels have been shown to correlate with better health outcomes and lower costs.
VA San Diego then uses that score to guide care interventions. VA San Diego provides heart failure patients with individual meetings and phone appointments over six months aimed at improving self-management, but the content varies based on the patient's starting activation level.
For example, sessions with patients with low activation levels might focus on basic clinical information, such as understanding their medications or knowing when to contact their general practitioner. Meanwhile, interactions with patients with a PAM level 4 might focus on more advanced situations, such as establishing plans to maintain new behaviours in times of stress.
As patients master new skills and knowledge and improve their self-management capabilities, they progress to the next activation level in the care pathway.
Extending the approach to other patient populations
A randomised study reviewed this approach and found that patients who had care tailored to their activation levels showed a significant increase in activation compared to the control group receiving usual care. In fact, after six months the intervention group ended up with an average activation level of 4, compared with 3 for the control group—a difference that has been shown to correlate with 8% lower costs. The group with tailored care also had 34.4% fewer patient readmissions on average than the control group at six months.
The results are impressive, and most importantly, VA San Diego's systematic approach can be applied to sustainably tailor care for a range of patient populations and conditions.