University of Oklahoma HSC, Department of Family and Preventive Medicine , Oklahoma City, Oklahoma, United States.
Appl Clin Inform. 2013 Feb 20;4(1):75-87. doi: 10.4338/ACI-2012-10-RA-0048. Print 2013.
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.
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.
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.
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.
健康风险评估（HRA）已在多种环境中实施，但很少有研究系统地检查计算机化 HRA 在初级保健中的影响。本研究旨在开发和试点测试一种新型的综合 HRA 工具在初级保健实践中。
我们设计、实施并试点测试了一种新的基于网络的 HRA 工具，在四个配对的干预和对照组初级保健实践中（N=200）。使用 HRA、患者调查和定性反馈在干预前和干预后 12 个月测量结果。干预组患者收到了 HRA 的详细反馈，并鼓励他们在下一次健康访问时讨论 HRA 报告，以制定个性化的健康计划。
预计寿命及其衍生物，包括实际年龄和健康评分，受到 HRA 实施的显著影响（P<0.001）。干预组 10 项预防措施的总体实施率提高了 4.2%，而对照组为 4.2%（P=0.001）。HRA 提高了以 CAHPS PCC-10 调查衡量的以患者为中心的护理（P=0.05）。HRA 的使用与更好的自我评估整体健康状况（OR=4.94；95%CI，3.85-6.36）和提高预防服务的最新性（OR=1.22；95%CI，1.12-1.32）密切相关。广义线性模型表明，健康评分的增加与以患者为中心的护理、预防服务的最新性以及干预组的提高相关（所有 P<0.03）。患者对他们的 HRA 体验感到满意，认为 HRA 报告相关且有激励作用，并认为它提高了他们的健康意识。临床医生强调，HRA 工具帮助他们和他们的患者就高影响力、基于证据的预防措施达成一致。
尽管存在研究限制，但结果表明，一种全面的、基于网络的、目标导向的 HRA 工具可以改善初级保健环境中预防服务的获得、以患者为中心的护理、行为健康结果和各种健康指标。
