Exploring Patient Activation in the Emergency Department at Maine Medical Center

Document Type


Publication Date



Maine Medical Center, Medical Education, Maine Medical Center Research Institute

MeSH Headings

Humans, Patient Participation, Maine, Hospitals, Emergency Service, Hospital


Background: The Patient Activation Measure (PAM-13) was designed to assess patients’ knowledge, skills, and confidence in managing health and healthcare as higher levels of activation and care engagement have been associated with improved outcomes. Little is known about activation in emergency department (ED) patients; thus, we sought to determine baseline levels of activation and associations with patient and visit characteristics in the ED setting.

Methods: We administered the PAM-13 to a convenience sample of adult patients receiving care in our Level-I tertiary ED. Patients were excluded if they could not read English or if their medical/cognitive condition precluded participation. Activation levels were collapsed (low vs. high activation) and were linked to patient and visit characteristics using electronic query of the health record.

Results: 200 patients participated in the study, 98 (49%) were female, median age 64 (range 21-95). PAM-13 scores ranged from 39.7 to 100, mean 67.2 (SD 13.25, 95% CI: 65.3-69.0). Scores stratified participants into four levels representing increasing degrees of activation: L1 (Disengaged/Overwhelmed) – 11(6%), L2 (Becoming Aware, Still Struggling) – 27(14%), L3 (Taking Action, Gaining Control) – 89(45%), and L4 (Maintaining Behaviors, Pushing Further) – 73(37%). Significant differences in activation were not noted based upon age, gender, payor type, mode of arrival, or ESI level (p>0.05 for each). Differences were also not noted based on visit characteristics including being seen in critical care, a hallway space, the rapid or clinical decision units; receiving a radiograph, computed tomography or magnetic resonance imaging; or having a 7- or 30-day revisit (p>0.05 for each). The number of laboratory or imaging procedures completed and ED length of stay also did not vary by activation level (p>0.05 for each).

Conclusions: In this sample, we did not observe significant differences in baseline patient activation based upon demographic and visit characteristics. Understanding that baseline patient and visit characteristics do not seem to influence activation supports the notion that the PAM-13 may be a useful tool for assessing activation in a wide range of adult ED patients. While the majority of participants (58%) reported higher levels of activation, concordance with actual health-supporting behaviors was not evaluated.


Award for Excellence in Quality Improvement Research: Trainee 1st Place Award - Scientific Talk at the 2020 Costas L. Lambrew Research Retreat.