Novel computerized health risk appraisal may improve longitudinal health and wellness in primary care: a pilot study

Abstract

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.

Keywords: Health risk appraisal; goal-directed care; health information technology; prioritization; wellness.

Fig. 1

Figure 1 Conceptual Model of the Health Risk Appraisal (HRA) Driven, Goal-Directed Care Approach (*) A comprehensive, web-based HRA is completed by the patient before each annual wellness visit as a “homework assignment” (from home, work, or via a wireless tablet in the practice) and a personalized -prioritized health report is generated to aid strategic care planning based on patient goals, needs, preferences, and constraints. (**) In this model, existing chronic health conditions and disease processes are considered risk factors for future adverse outcomes (e.g., myocardial infarction or stroke) that can result in decreased life expectancy and diminished quality of life. This holistic, patient goal-directed care approach encompasses the majority of primary care and integrates biomedical, behavioral, and psychosocial determinants of health into a unified health improvement strategy.

Fig. 2

Participant flow diagram of the health risk appraisal pilot study⁽¹⁾ The inclusion criteria for practices were: practice is stable, no concurrent implementation of another major intervention, willingness and capacity to adopt the HRA tool, and clinician sees at least 30 middle-aged and older adults per week. ⁽²⁾ Convenience sample was chosen to maximize the chance of successful implementation and testing based on practice characteristics and available study resources. ⁽³⁾ A quasi-experimental, controlled design was followed, including pair-matching of control and intervention sites based on practice and patient care characteristics.