Novel Computerized Health Risk Appraisal May Improve Longitudinal Health and Wellness in Primary Care

SummaryObjectives: 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: 75–87http://dx.doi.org/10.4338/ACI-2012-10-RA-0048

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0489 Initial Results from the Hypertension with Unsatisfactory Sleep Health (HUSH) Clinical Trial for Primary Care Patients with Insomnia and Comorbid Hypertension (INS-HTN)

SLEEP ◽

10.1093/sleep/zsaa056.486 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A187-A188

Author(s):

D J Buysse ◽

L M Ritterband ◽

J G Yabes ◽

B L Rollman ◽

P J Strollo ◽

...

Keyword(s):

Primary Care ◽

Sleep Disturbance ◽

Intervention Group ◽

Self Report ◽

Apnea Hypopnea Index ◽

Dissemination And Implementation ◽

Patient Reported ◽

Primary Care Patients ◽

Care Practices ◽

Primary Care Practices

Abstract Introduction Insomnia is commonly comorbid with, and may contribute to, hypertension. Cognitive-behavioral treatments improve insomnia, but their effects on hypertension are uncertain, and they are often unavailable in primary care practices, where most INS-HTN patients are treated. We evaluated the efficacy of Brief Behavioral Treatment for Insomnia (BBTI) and Sleep Healthy Using the Internet (SHUTi) compared to enhanced usual care (EUC) on insomnia and home blood pressure (HBP) in primary care patients with INS-HTN. Methods Patients were recruited via electronic health records from 67 primary care practices and randomized 2:2:1 to BBTI delivered via telephone/videoconferencing; SHUTi, an automated, web-based CBT-I program; or EUC including a patient education video. Assessments included self-report questionnaires, home sleep apnea testing, and one week of sleep diary and HBP, measured at Baseline and 9 weeks/ 6 months post-treatment. The primary outcome was the Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance scale. Linear mixed models were fitted for continuous variables on the intent-to-treat sample (n=548), adjusting for age and sex. Chi-square tests were used for proportions. Results Patients were 61.8±11.3 years old, 67.2% female, and 55.9% were taking hypnotics. Insomnia Severity Index (ISI) was 15.4±4.4, Apnea-Hypopnea Index 9.8±11.4, and HBP 130±14/81±9. BBTI and SHUTi were significantly better than EUC (p≤.002) at 9 weeks and 6 months on PROMIS Sleep Disturbance and Sleep-Related Impairment scales, ISI, and diary sleep efficiency, but had inconsistent effects on PROMIS depression and anxiety scales (p=0.001-0.9). Greater proportions of BBTI and SHUTi vs. EUC-treated patients had 9-week and 6-month ISI scores <8 (p=.01, p=.04) and ISI changes scores ≥7 (p=.002, p=.003). HBP did not significantly differ by intervention group. Conclusion BBTI and SHUTi improved insomnia, but did not reduce HBP in patients with INS-HTN. These interventions appear suitable for dissemination and implementation in primary care, but may have limited effects on comorbid symptoms and conditions. Support NHLBI UH2/UH3 HL125103

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Decrease in Cardiovascular Disease Risk Due to a National Initiative to Improve Preventive Services in Small Primary Care Practices

Health Services Research ◽

10.1111/1475-6773.13830 ◽

2021 ◽

Vol 56 (S2) ◽

pp. 77-77

Author(s):

Stephan Lindner ◽

Thomas Kottke ◽

Bijal Balasubramanian ◽

John McConnell ◽

Miguel Marino ◽

...

Keyword(s):

Cardiovascular Disease ◽

Primary Care ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

Preventive Services ◽

National Initiative ◽

Small Primary ◽

Care Practices ◽

Primary Care Practices

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Measuring the Process of Preventive Service Delivery in Primary Care Practices for Children

PEDIATRICS ◽

10.1542/peds.106.s3.879 ◽

2000 ◽

Vol 106 (Supplement_3) ◽

pp. 879-885

Author(s):

Kathleen L. Gest ◽

Peter Margolis ◽

W. Clayton Bordley ◽

Jayne Stuart

Keyword(s):

Primary Care ◽

Service Delivery ◽

Care Delivery ◽

Preventive Services ◽

Office Visit ◽

Screening Tests ◽

Preventive Service ◽

Care Practices ◽

Primary Care Practices ◽

Key Steps

Background. Children may fall behind on preventive services because they do not receive needed services at the time of an office visit (a missed opportunity). However, methods are needed to measure problems in the care delivery process that lead to missed opportunities. We developed a method to examine the key steps in the preventive service delivery process and identify problems; we assessed the feasibility and validity of the method in primary care practices for children. Methods. Using 3 data collection methods, we measured key steps in the process of preventive service delivery in primary care offices: a chart audit was used to measure each child's preventive service status before and after an office visit, a brief parent exit interview was used to assess preventive service delivery not documented in the chart, and a staff checklist was used to assess the role of nursing and other office staff. The feasibility of using this combination of measures to identify problems in the care delivery process was evaluated in 3 representative primary care practices (2 pediatric, 1 family practice) among children 5 years and younger. Results. The measurement method was implemented in all 3 practices. The validity of the method was supported by its ability to detect differences among practices in the proportion of children eligible for immunizations and screening tests and in the proportion of children undergoing key steps in the process of preventive service delivery. The practice with the lowest proportion of children whose charts were screened for preventive services needs had the lowest performance of preventive services. Conclusions. It is possible to assess specific elements in the process of preventive service delivery in primary care practices. Use of this approach may help practices design and monitor interventions to improve the quality of preventive care delivery.

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