This year, developments with the Altarum Consumer Engagement (ACE) Measure have been very exciting: More and more health care organizations are using ACE to better understand and promote patient engagement, Altarum Institute has had a chance to share the news about ACE at several webinars and presentations, and Altarum’s validation research manuscript was published in The Patient.
ACE is a short survey that reliably measures different components of patient engagement. ACE is highly predictive of many different health outcomes and behaviors, from obesity to medication adherence to preferences for shared decisionmaking. Health care organizations, providers, and patients can use ACE to understand patient strengths and weaknesses, likely pitfalls, and who is likely to benefit most from extra assistance, such as a patient support group or health care navigator. Altarum’s licensing agreement does not require any payment, so anyone can use ACE, regardless of one’s resources.
Altarum has some more exciting news to share. We have shortened the ACE survey from 21 items to 12 while keeping the same high-powered predictive strength. The entire ACE Measure now takes about 2 minutes to complete, down from 4 minutes, making it more accessible to busy respondents. Our goal was to make the survey as short as possible without sacrificing any strength in predicting health outcomes. We did this by identifying the questions that had the least unique predictive power. Several items were psychometrically a good fit on the scale, but other questions captured their core essence, so these non-unique questions could safely be removed. With this technique, the correlation r values for Commitment, Informed Choice, and Navigation were all an astounding 0.97, meaning that the results are virtually identical between old and new scales, but with nearly half as many questions.
In making a new and improved version of ACE, Altarum found that for most outcomes predicted by the Ownership scale, the Commitment scale did the job just as well or better. Ownership describes a sense of personal responsibility for health, while Commitment captures everyday health behaviors and health self-efficacy. While these are different concepts psychometrically, they translate into the same constellation of outcomes and behaviors. Because of this, we made the decision to remove the Ownership scale in ACE-12, using Commitment in its place.
Using the new ACE in the care setting
An advantage of a shorter ACE survey is its ease of deployment in the situations where it is needed most, such as in the doctor’s office or on a patient portal. I would like to share how ACE is being used in the care setting.
One of the hospital systems with which Altarum works treats patients from many different backgrounds. They found that many of their patients with chronic disease would enthusiastically start treatment and then suddenly disappear, no longer meeting with providers or filling prescriptions. When these patients came back, their condition had often deteriorated significantly. The hospital staff wondered what they could do to prevent the loss of these patients. Were there ways to (1) predict who was likely to drop out of treatment and (2) get these vulnerable patients the extra support to prevent their conditions from worsening?
The solution that Altarum created was that a patient could take the new ACE-12 patient engagement survey on a computer or a tablet while waiting to see his or her provider. Once completed, a report is printed out, detailing each engagement score and specific areas where the patient is likely to do well and where he or she is likely to need help. For example, a patient’s report could indicate that he or she is at risk of low medication adherence or missing needed care. Another patient might have excellent adherence but need a health care navigator to make full use of his or her health care. The provider talks through the report with the patient, introducing the importance of patient engagement, raising self-awareness in the patient, and assigning extra resources as necessary to make sure that that patient does not miss out on the care that he or she needs.
It is an exciting time for ACE. We will continue to blog about more innovative ways of leveraging patient engagement. If you would like to use ACE in your own organization, please email Altarum at firstname.lastname@example.org.