The Patient Centered Assessment Method (PCAM) is a tool medical practitioners can use to assess patient complexity using the social determinants of health that often explain why some patients engage and respond well in managing their health while others with the same or similar health conditions do not experience the same outcomes.
Understanding the patient’s health and wellbeing (lifestyle behaviors, impact of their physical health on their mental health, their ability to enjoy daily activities), their social environment (status of employment, housing, transportation, social networks), and their health literacy and communication skills (understanding of their symptoms and risk factors, language and cultural differences, learning difficulties) may indicate other factors that are affecting the person’s ability to manage their health.
Patient complexity may be due to multiple chronic medical conditions or to due social and environmental factors. It is very likely a combination of both. Factors that interfere with a patient’s usual care and decision-making can make providing health care more difficult and complex and can impact the patient’s health and recovery. As a provider, learning these factors and addressing them as part of the patient’s medical care holds promise for improving patient health and improving patient-provider relationships.
The PCAM is a systematic tool to identify these factors and their impact on patients. It offers providers a method to better understand their patient’s needs beyond their medical condition(s). It is action-oriented with the final section focused on the actions that can be taken to address the needs and issues identified in the assessment as well as the level of service coordination needed to ensure referrals can be practically accessed by the patient.
A program of work on the implementation, impact on health outcomes and validation work is ongoing. This website is under ongoing development and will be periodically updated with key links to peer-review articles, research reports and materials to support training.
How to Use PCAM
PCAM is copyrighted, and the developer team is committed to it being freely available for use. PCAM is best implemented with the support of training for clinicians, and consideration of how systems support the integration of the tool.
Our Training & Resources section contains a number of resources and training tools you can download and use for your training and implementation. We are available to consult with you as you consider your implementation of the PCAM tool in your practice.
Training & Resources
Resources for PCAM users
- PCAM Tool
- PCAM Assessor Guide - This guide offers suggestions for the types of questions to ask for each of the PCAM sections.
- PCAM Quick Card - A short quarter-page pocket guide to the PCAM domains you may find helpful as you master using PCAM.
- PCAM for Research - This PCAM tool contains research scoring numbers in each section to aid in conducting research with PCAM assessments.
PCAM (then called MECAM) was tested in the context of a preventative screening program in Scotland. This mixed methods prospective cohort study undertook face validation testing, conducted preliminary external validity testing, piloted implementation, and conducted a case study in a population of known complexity. Three primary care sites in areas of high deprivation in Scotland participated. The research found PCAM offered much promise as an assessment of complexity that identifies biopsychosocial complexity, and supports clinician decision making to address those needs. With training and practice it can be easily integrated into nurse led health checks. PCAM appeared to offer good potential to support collaborative and integrated consultations, and may increase the referral of patients to a wider range of resources. The full report of this research (including methods) can be found below.
Subsequent research studies have explored the feasibility of implementing PCAM in primary care settings with patients who have long term care needs, the incorporation of PCAM in health information exchanges to prevent hospital re-admissions with patients served in multiple care settings, and a study assessing patient complexity with hospitalized patients and their length of stay in the hospital.
Yoshida S, Matsushima M, Wakabayashi R, et al, 2019. Correlation of patient complexity with the burden for health related professions, and differences in the burden between the professions at a Japanese regional hospital.
Maxwell M, Hibberd C, Aitchison P, Calveley E, Pratt, R, et al, 2018. The Patient Centred Assessment Method for improving nurse-led biopsychosocial assessment of patients with long-term conditions: A feasibility RCT.
Bujold M, Pluye P, Légaré F, et al, 2017. Decisional needs assessment of patients with complex care needs in primary care: a participatory systematic mixed studies review protocol.
Hewner S, Casucci S, Sullivan S, et al, 2017. Integrating social determinants of health into primary care clinical and informational workflow during care transitions.
Yoshida S, Matsushima M, Wakabayashi H, et al, 2107. Validity and reliability of the Patient Centred Assessment Method for patient complexity and relationship with hospital length of stay: a prospective cohort study.
Pratt R, Hibberd C, Cameron I, Maxwell M, 2015. The Patient Centered Assessment Method (PCAM): integrating the social dimensions of health into primary care
Maxwell M, Hibberd C, Pratt R, Cameron I, Mercer S, 2011. Development and Initial Validation of the Minnesota Edinburgh Complexity Assessment Method (MECAM) for use within the
Keep Well Health Check
Peek CJ, Baird M, Coleman E, 2009. Primary Care for Patient Complexity, Not Only Disease
Rebekah Pratt, PhD, University of Minnesota, USA
Margaret Maxwell, PhD, University of Stirling, Scotland
Carina Hibberd, PhD University of Stirling, Scotland
Macaran Baird, MD, University of Minnesota, USA
C J Peek, PhD, University of Minnesota, USA
Stewart Mercer, MD, University of Glasgow, Scotland
Isobel Cameron, PhD, University of Aberdeen, Scotland
All materials in this website (including without limitation all models, text, images, logos, etc.) are © Maxwell, Pratt, Hibberd, Baird, and Peek, 2013. The Universities of Stirling and Minnesota own the copyright to the PCAM Tool which has been developed with the permission of University of Minnesota, from the Minnesota Complexity Method (MCAM), an assessment method developed by Drs Baird, Peek and Coleman at the Department of Family Medicine and Community Health at the University of Minnesota and was adapted by permission from earlier work by Dr F Huyse, et al, in the Netherlands. The Universities of Stirling and Minnesota were supported in developing MECAM which is now known as PCAM for use in Scotland by funding from NHS Health Scotland. The content of this website may not be copied or shared with any third party without inclusion of this copyright declaration. There are no license costs for the use of PCAM and the developers are committed to PCAM being freely available to use.