Novel Computerized Health Risk Appraisal May Improve Longitudinal Health and Wellness in Primary CareA Pilot Study
30 October 2012
accepted: 09 January 2013
19 December 2017 (online)
Objectives: Health Risk Appraisals (HRAs) have been implemented in a variety of settings, however few studies have examined the impact of computerized HRAs systematically in primary care. The study aimed at the development and pilot testing of a novel, comprehensive HRA tool in primary care practices.
Methods: We designed, implemented and pilot tested a novel, web-based HRA tool in four pair-matched intervention and control primary care practices (N = 200). Outcomes were measured before and 12 months after the intervention using the HRA, patient surveys, and qualitative feedback. Intervention patients received detailed feedback from the HRA and they were encouraged to discuss the HRA report at their next wellness visit in order to develop a personalized wellness plan.
Results: Estimated life expectancy and its derivatives, including Real Age and Wellness Score were significantly impacted by the HRA implementation (P<0.001). The overall rate of 10 preventive maneuvers improved by 4.2% in the intervention group vs. control (P = 0.001). The HRA improved the patient-centeredness of care, measured by the CAHPS PCC-10 survey (P = 0.05). HRA use was strongly associated with better self-rated overall health (OR = 4.94; 95% CI, 3.85–6.36) and improved up-to-dateness for preventive services (OR = 1.22; 95% CI, 1.12–1.32). A generalized linear model suggested that increase in Wellness Score was associated with improvements in patient-centeredness of care, up-to-dateness for preventive services and being in the intervention group (all P<0.03). Patients were satisfied with their HRA-experience, found the HRA report relevant and motivating and thought that it increased their health awareness. Clinicians emphasized that the HRA tool helped them and their patients converge on high-impact, evidence-based preventive measures.
Conclusions: Despite study limitations, results suggest that a comprehensive, web-based, and goal-directed HRA tool can improve the receipt of preventive services, patient-centeredness of care, behavioral health outcomes, and various wellness indicators in primary care settings.
Citation: Nagykaldi ZJ, Voncken-Brewster V, Aspy CB, Mold JW. Novel Computerized Health Risk Appraisal May Improve Longitudinal Health and Wellness in Primary Care. Appl Clin Inf 2013; 4: 75–87
- 1 Advisory Committee on Immunization Practices (ACIP) Preventive Services Recommendations. http://www.cdc.gov/vaccines/acip/recs/index.html (December 15).
- 2 American Academy of Family Physicians Clinical Guidelines.. Clinical Policies and Guidelines. http://www.aafp.org/online/en/home/clinical/clinicalrecs/guidelines.html (December 15).
- 3 United States Preventive Services Task Force (USPSTF).. Preventive Services Recommendations. http://www.uspreventiveservicestaskforce.org (December 14).
- 4 Beery WL, Greenwald HP. A modified health risk appraisal as a component of a senior health promotion program. HMO Pract 1996; 2: 91-94.
- 5 Card D, Krueger AB. Minimum Wages and Employment: A Case Study of the Fast-Food Industry in New Jersey and Pennsylvania. American Economic Review 1994; 4: 774-775.
- 6 Cox DR. Regression Models and Life Tables. Journal of the Royal Statistical Society Series B 1972: 187-220.
- 7 Cyrus Baghelai MS, Valerie S, Nelkin MA, Ted R. Miller Ph. D. (Econometrica, Inc).. Health Risk Appraisals in Primary Care: Current Knowledge and Potential Applications To Improve Preventive Services and Chronic Care. Rockville, MD: AHRQ Center for Primary Care, Prevention, and Clinical Partnerships; 2010
- 8 Fuji KT, Galt KA, Serocca AB. Personal health record use by patients as perceived by ambulatory care physicians in Nebraska and South Dakota: a cross-sectional study. Perspect Health Inf Manag; 2008: 15.
- 9 Halpin HA, McMenamin SB, Schmittdiel J, Gillies RR, Shortell SM, Rundall T, Casalino L. The routine use of health risk appraisals: results from a national study of physician organizations. Am J Health Promot 2005; 1: 34-38.
- 10 Hays RD, Shaul JA, Williams VS, Lubalin JS, Harris-Kojetin LD, Sweeny SF, Cleary PD. Psychometric properties of the CAHPS 1.0 survey measures. Consumer Assessment of Health Plans Study. Med Care 1999; (Suppl. 03) MS22-31.
- 11 Hibbard JH, Stockard J, Mahoney ER, Tusler M. Development of the Patient Activation Measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Serv Res 2004; 4 Pt 1: 1005-26. doi: 10.1111/j.1475-6773.2004.00269.x.
- 12 Hudson LR, Pope JE. The role of health-risk appraisals in disease management. Manag Care Interface 2006; 2: 43-5.
- 13 Kessler R, Glasgow RE. A proposal to speed translation of healthcare research into practice: dramatic change is needed. Am J Prev Med 2011; 6: 637-44. doi: S0749-3797(11)00162-0 [pii] 10.1016/j.amepre.2011.02.023.
- 14 Kittler AF, Carlson GL, Harris C, Lippincott M, Pizziferri L, Volk LA, Jagannath Y, Wald JS, Bates DW. Primary care physician attitudes towards using a secure web-based portal designed to facilitate electronic communication with patients. Inform Prim Care 2004; 3: 129-138.
- 15 Krist AH, Peele E, Woolf SH, Rothemich SF, Loomis JF, Longo DR, Kuzel AJ. Designing a patient-centered personal health record to promote preventive care. BMC Med Inform Decis Mak 2011; 73. doi: 1472-6947-11-73 [pii] 10.1186/1472-6947-11-73.
- 16 Mold JW, Blake GH, Becker LA. Goal-oriented medical care. Fam Med 1991; 1: 46-51.
- 17 Mold JW, Hamm R, Scheid D. Evidence-based medicine meets goal-directed health care. Fam Med 2003; 5: 360-364.
- 18 Morgan RF, Wilson J. Growing Younger.. How to Measure and Change Your Body’s Age. Morgan Foundation September 2000
- 19 Nagykaldi Z, Mold JW. The role of health information technology in the translation of research into practice: an Oklahoma Physicians Resource/Research Network (OKPRN) study. J Am Board Fam Med 2007; 2: 188-95. doi: 10.3122/jabfm.2007.02.060084.
- 20 Nagykaldi Z, Aspy CB, Chou A, Mold JW. Impact of a Wellness Portal on the delivery of patient-centered preventive care. J Am Board Fam Med 2012; 2: 158-67. doi: 10.3122/jabfm.2012.02.110130.
- 21 Rubenstein L SP, Tucker J, Maglione M, Morton S, Roth E, Chao B, Rhodes S, Wu S, Newberry S. Health Risk Appraisals and Medicare. Baltimore: US Department of Health and Human Services, Health Care Financing Administration; 2003
- 22 Silvestre AL, Sue VM, Allen JY. If you build it, will they come? The Kaiser Permanente model of online health care. Health Aff (Millwood) 2009; 2: 334-44. doi: 28/2/334 [pii] 10.1377/hlthaff.28.2.334.
- 23 Siontis GC, Tzoulaki I, Ioannidis JP. Predicting death: an empirical evaluation of predictive tools for mortality. Arch Intern Med 2011; 19: 1721-6. doi: archinternmed.2011.334 [pii] 10.1001/archinternmed.2011.334.
- 24 Sobel DS. Rethinking medicine: improving health outcomes with cost-effective psychosocial interventions. Psychosom Med 1995; 3: 234-244.
- 25 Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: translating evidence into action. Health Aff (Millwood) 2001; 6: 64-78.