Appl Clin Inform - Novel computerized health risk appraisal may improve longitudinal health and wellness in primary care: a pilot study.


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JECTIVES: 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.

Resumo Limpo

jectiv health risk apprais hras implement varieti set howev studi examin impact computer hras systemat primari care studi aim develop pilot test novel comprehens hra tool primari care practicesmethod design implement pilot test novel webbas hra tool four pairmatch intervent control primari care practic n outcom measur month intervent use hra patient survey qualit feedback intervent patient receiv detail feedback hra encourag discuss hra report next well visit order develop person well planresult estim life expect deriv includ real age well score signific impact hra implement p overal rate prevent maneuv improv intervent group vs control p hra improv patientcentered care measur cahp pcc survey p hra use strong associ better selfrat overal health ci improv uptod prevent servic ci general linear model suggest increas well score associ improv patientcentered care uptod prevent servic intervent group p patient satisfi hraexperi found hra report relev motiv thought increas health awar clinician emphas hra tool help patient converg highimpact evidencebas prevent measuresconclus despit studi limit result suggest comprehens webbas goaldirect hra tool can improv receipt prevent servic patientcentered care behavior health outcom various well indic primari care set

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