Practical, Patient Report Measures for Primary Care: Progress on the My Own

Health Report (MOHR) Project to Date

Bijal Balasubramanian Maria FernandezRuss Glasgow

Beth GlennMarcia Ory

Catherine Rohweder for the MOHR Research Group

Overview•Context and Design: Russ•Pragmatic Research Features: Marcia•Group Discussion of Above: All

Results•Early Results: Reach: Maria•Early Results: Health Behaviors(baseline): Beth•Group Discussion of Above: All

Lessons Learned Thus Far: Catherine•General Discussion and Future Directions

Topics to be Covered

Vision for Vision for ““Big DataBig Data””—A Comprehensive —A Comprehensive Big Database to be Maximally Useful Big Database to be Maximally Useful Should Contain:Should Contain:

• Geospatial and social/physical/environmental data on fundamental determinants of health

• Diagnostic and health care utilization data

• Genomic and biomarker data

• Patient-reported information, preferences, and patient-centered goals- this is MOHR contribution

• Advent of patient-centered medical home, CMS annual wellness exams, “meaningful use” of EHRs

• In the billions of dollars spent on EHRs in last several years, one thing is missing: Patient-Reported Measures

• Impossible to provide patient-centered care if no patient measures, goals, preferences, concerns collected

• With recent advances in measurement, meaningful use incentives, time is right

EHR Measures for Primary Care

Estabrooks PA, et al. Harmonized patient-reported data elements…J Am Med Inform Assoc 2012 Jul-Aug;19(4):575-82.

Participatory Implementation ProcessIterative, wiki activities to engage

stakeholder community, measurement experts and diverse perspectives

Practical Progress MeasuresBrief, tested, standard patient-reported

data items on health behaviors & psychosocial issues—actionable and administered longitudinally to assess

progress

Intervention Program/PolicyEvidence-based decision aids to provide feedback to both patients and health care

teams for action planning and health behavior counseling

Multi-Level Context• Dramatic increase in use of EHR • CMS funding for annual wellness exams

• Primary Care Medical Home • Meaningful use of EHR requirements

Feed

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Feedback

Evidence:US Preventive Services Task Force

recommendations for health behavior change counseling; goal setting & shared decision

making

Stakeholders:Primary care (PC) staff, patients and consumer

groups; health care system decision makers; groups involved in meaningful use of EHRs

Evidence Integration Triangle (EIT)—A Patient-Centered Care Example

Glasgow RE, et al. An evidence integration triangle…Am J Prev Med 2012;42(6):646-654.

Domain Final Measure (Source)1. Overall Health Status 1 item: BRFSS Questionnaire

2. Eating Patterns 3 items: Modified from Starting the Conversation (STC)[Adapted from Paxton AE et al. Am J Prev Med 2011;40(1):67-71]

3. Physical Activity 2 items: The Exercise Vital Sign [Sallis R. Br J Sports Med 2011;45(6):473-474]

4. Stress 1 item: Distress Thermometer [Roth AJ, et al. Cancer 1998;15(82):1904-1908]

5. Anxiety and Depression 4 items: Patient Health Questionnaire—Depression & Anxiety (PHQ-4) [Kroenke K, et al. Psychosomatics 2009;50(6):613-621]

6. Sleep 2 items: a. Adapted from BRFSSb. Neuro-QOL [Item PQSLP04]

7. Smoking/Tobacco Use 2 items: Tobacco Use Screener [Adapted from YRBSS Questionnaire]

8. Risky Drinking 1 item: Alcohol Use Screener [Smith et al. J Gen Int Med 2009;24(7):783-788]

9. Substance Abuse 1 item: NIDA Quick Screen [Smith PC et al. Arch Int Med 2010;170(13):1155-1160]

10. Demographics 9 items: Sex, date of birth, race, ethnicity, English fluency, occupation, household income, marital status, education, address, insurance status, veteran’s status. Multiple sources including: Census Bureau, IOM, and National Health Interview Survey (NHIS)

Measures for Adult Primary Care

• Patient Fills Out Tool

My Own Health Report (MOHR) Automated Assessment Tool

‣ Database oftext messagesand triggers

‣ Research analysis‣ Report datastored in database

‣ Action Plan printout

‣ Summary display and printout for patient

‣ Summary display and printout for health care team

Krist A, et al. Designing a valid pragmatic primary care implementation trial…Implement Sci , 2013, 8:73

www.MyOwnHealthReport.org

Basic patient and

clinician goal advice (electronic)

and goal setting (paper)

‣ Cluster randomized trial of 9 clinic pairs, staggered early and late intervention

‣ Approximately half of clinics community health centers; others AHRQ type PBRN clinics

‣ Diverse sample of clinics and patients—e.g., varying levels of clinic integration of EHRs; urban, rural, suburban; large and small clinics;

‣ Study goal = Sustainable, routine use of intervention

VA

TX

VT

CA

OR

NC

www.myownhealthreport.org

MOHR Project—Key Points

• Primary Outcome = Percent and representativeness of patients who have a personalized action plan set

• Secondary Outcomes = Percent who receive follow-up contacts; improvement on health behaviors and mental health issues; costs and resources required

MOHR Key Outcomes

• Cost Collected 2x in early intervention sites

• Clinic Context Collected 3x pre-, mid-, post-intervention,

qualitative template• Project Context

Collected once, end of project, open-ended survey of key project stakeholders (e.g., researchers, funders)

• Post-Implementation Interview Group interview, clinic staff

Other Important Data Collected Other Important Data Collected in MOHRin MOHR