Brief Action Planning to Facilitate Behavior Change and Support Patient Self-Management

Given the challenges of providers practicing, learning, and using each of these approaches, efforts to develop an approach that supports patients to make behavioral changes that can be implemented in typical practice settings are needed. In addition, health delivery systems are transforming to team-based models with emphasis on leveraging each team member’s expertise and licensure [19]. In acknowledgement of these evolving practice realities, the National Committee for Quality Assurance (NCQA) included development and documentation of patient self-management plans and goals as a critical factor for achieving NCQA Patient-Centered Medical Home (PCMH) recognition [20]. Successful PCMH transformation therefore entails clinical practices developing effective and time efficient ways to incorporate self-management support strategies, a new service for many, into their care delivery systems often without additional staffing.

In this paper, we describe an evidence-informed, efficient self-management support technique called Brief Action Planning (BAP) [21–24]. BAP evolved into its current form through ongoing collaborative efforts of 4 of the authors (SC, DG, CD, KR) and is based on a foundation of original work by Steven Cole with contributions from Mary Cole in 2002 [25]. This technique addresses many of the barriers providers have cited to providing self-management support, as it can be used routinely by both individual providers and health care teams to facilitate patient-centered goal setting and action planning. BAP integrates principles and practice of MI with goal setting and action planning concepts from the self-management support, self-efficacy, and behavior change literature. In addition to reviewing the principles and theory that inform BAP, we introduce the steps of BAP and discuss practical considerations for incorporating BAP into clinical practice. In particular, we include suggestions about how BAP can be used in team-based clinical practice settings within the PCMH. Finally, we present a common clinical scenario to demonstrate BAP and provide resource links to online videos of BAP encounters. Throughout the paper, we use the word “clinician” to refer to professionals or other trained personnel using BAP, and “patient” to refer to those experiencing BAP, recognizing that other terms may be preferred in different settings.

What is BAP?

BAP is a highly structured, stepped-care, self-management support technique. Composed of a series of 3 questions and 5 skills (reviewed in detail below), BAP can be used to facilitate goal setting and action planning to build self-efficacy in chronic illness management and disease prevention [21–24]. The overall goal of BAP is to assist an individual to create an action plan for a self-management behavior that they feel confident that they can achieve. BAP is currently being used in diverse care settings including primary care, home health care, rehabilitation, mental health and public health to assist and empower patients to self-manage chronic illnesses and disabilities including diabetes, depression, spinal cord injury, arthritis, and hypertension. BAP is also being used to assist patients to develop action plans for disease prevention. For example, the Bellevue Hospital Personalized Prevention clinic, a pilot clinic that uses a mathematical model [26] to help patients and providers collaboratively prioritize prevention focus and strategies, systematically utilizes BAP as its self-management support technique for patient-centered action planning. At this time, BAP has been incorporated into teaching curriculums at multiple medical schools, presented at major national health care/academic conferences and is being increasingly integrated into health delivery systems across the United States and Canada to support patient self-management for NCQA-PCMH transformation. We have also developed a series of standardized programing to support fidelity in BAP skills development including a multidisciplinary introductory training curriculum, telephonic coaching, interactive web-based training tools, and a structured “Train the Trainer” curriculum [27]. In addition, a set of guidelines designed to ensure fidelity in BAP research has been developed [27].