Ask just a few questions to gauge health status
Ask just a few questions to gauge health status
Computer-based system makes assessment easy
Gauging patients’ functional health status will become as commonplace in physician practices as measuring their blood pressure, predicts John E. Ware Jr., PhD, a pioneer in the field of health status assessment and president of QualityMetric in Lincoln, RI. But first, he acknowledges, it must be as quick, easy, and accurate as well.
Ware promises to bridge that gap with the computer-based Dynamic Health Assessment System (DynHA), produced by QualityMetric. The system allows patients to answer just a handful of questions but provides a precise score on physical and mental health functioning.
Basically, DynHA functions as a customized questionnaire for each respondent. The questions are selected from a large pool (perhaps hundreds of potential health status items) based on the patient’s previous answers. For example, a patient who says she can easily walk a mile would not be asked if she can walk around the block. That means an end to long, cumbersome paper forms without sacrificing the statistical precision that those lengthy questionnaires provide.
"If they’re a high-scoring patient, we ask high-scoring questions," he explains. "If they’re a low-scoring patient, we ask low-scoring questions. The computer picks the questions that are appropriate for that particular patient. It stops as soon as it knows the score at the preset level [of statistical precision]."
Ware says he envisions the DynHA System as a tool for outcomes management of individual patients, for disease management programs, and for use in clinical trials. Glaxo Wellcome of Research Triangle Park, NC, is sponsoring the first disease-specific version for migraines. That tool and the generic version will be available later this year.
Health status tools slowly catch on
The concept of measuring outcomes from the patient’s perspective is slowly gaining acceptance. Last year, managed care organizations used a Health of Seniors assessment tool to measure a sample of Medicare patients. In two years, those organizations will report whether the population’s health improved or declined. (See Patient Satisfaction & Outcomes Management, January 1999, p. 9.)
But health status assessment surveys such as the SF-36 and SF-12, developed by Ware, haven’t been widely used in physician practices, even though software vendors offer touch screen, scanning, and faxed reports.
"Doctors aren’t thinking this way," he says. "It’s not on their radar screen. We have a major challenge to educate the physician community that just as they monitor the organs of your body, they need to monitor you overall."
Yet existing health status surveys have drawbacks as individual outcomes management tools. "Short forms were designed to reduce the burden [of long questionnaires], but they added a margin of error that really didn’t allow physicians to make certain decisions at the patient level," says Ralph Perfetto, MBA, chief operating officer of QualityMetric. "It’s like a blood pressure cuff that gave you the blood pressure, plus or minus 25."
With DynHA, the precision depends on the number of questions in the item pool — the total number of potential questions the computer considers asking a respondent. Ware is including questions from a wide range of health status assessment and quality-of-life surveys. "We expect that the item pools [of possible questions] will continue to grow and improve" even beyond the initial development, says Perfetto.
The initial emphasis in item development is on physical functioning, mental health, and social role disability, or how illness is affecting the patient’s ability to function in social roles such as working or interacting with friends and family. The dynamic assessment will provide scores for other domains of the SF-36, such as vitality or pain. "We’re putting a very high priority on disability as a generic concept and a disease-specific concept because it’s so economically and socially relevant," says Ware.
System offers easy connections
How can you gauge a patient’s health status without taking up valuable time during an office visit? Solving that question is an important part of making the assessment useful to individual physicians, says Ware.
The DynHA System will be available through a password-coded Internet site, he says. It also could be connected through interactive voice recognition systems, in which patients call a number and answer questions over the phone.
"We’ve got to make this very simple, very practical to get it into clinical practice at a large scale," says Ware. "This isn’t something that’s going to happen while the doctor and patient are together. It’s a result, a lab result, in front of the doctor when he or she sees the patient."
Managed care organizations have expressed interest in the assessment system, which could be used as a part of a disease management program, says Lisa Bowen, QualityMetric’s vice president of business development and marketing. The results would be forwarded to physicians, who could then gauge the effectiveness of treatment for chronic illnesses.
Health status assessment promises to empower patients, but they will need to learn about their new role, says Ware.
"Patients are used to going to the doctor to find out how they’re doing," he says. "Now they’re going to go to the doctor and tell [him or her] how they’re doing. They need to be prepared for their new authority."
[Editor’s note: For more information about the DynHA system, contact Lisa Bowen, Vice President, Business Development and Marketing, QualityMetric, 640 George Washington Hwy., Lincoln, RI 02865. Telephone: (401) 334-8800. E-mail: [email protected]. World Wide Web: http://www.qmetric.com.]
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