On-line assessment offers quick route to outcomes

Dynamic’ surveys target questions to patients

Would you use health status questionnaires with your patients if they were quick, accurate — and free of charge?

It’s now possible to access health status surveys through a new Web site — www.amIhealthy.com — sponsored by QualityMetric of Lincoln, RI. Patients and physicians can tap into the power of a new "dynamic assessment" method of measuring health status without investing in special software, scanning devices, or consulting services.

QualityMetric, headed by John E. Ware Jr., CEO and developer of the widely used SF-36 health status survey, launched the Web site this summer at a conference of the International Headache Society. Within five days, it received 750,000 "hits," a measure of Web traffic.

The site highlights an interactive Headache Impact Test, which gives patients a percentile ranking for the severity of the symptoms by asking only a handful of targeted questions. Patients also can receive scores for physical and emotional health on a general health survey, also by answering as few as four questions.

The Dynamic Health Assessment (DynHA) system contains a large pool of potential questions but only asks those that are relevant based on prior answers. For example, if the patient answers that he or she isn’t limited in everyday activities such as climbing stairs, then the dynamic survey won’t ask about moderate activities such as using a vacuum cleaner or bowling.

"For nine out of 10 people, [the survey] will be over in four or five questions," says Ware. "It’s just that the questions will be different."

Patients can take the on-line survey at home and bring the results to their physicians. Or, for a fee that is based on their volume of usage, physicians can register and receive more detailed information that can be sent to them electronically.

"Indefinitely, we’re going to provide a free public service," says Ware, who originally intended to demonstrate the site at the conference, then continue to work on its design. The development of an interactive headache assessment was sponsored by the Glaxo Wellcome pharmaceutical firm.

"We’ve already had a number of doctors call up and say, What if I had my patients do this and get their scores, would it still be free?’ The answer is yes," says Ware.

Docs, patients use on-line health info

The QualityMetric Web site comes as both patients and physicians are using the Internet in unprecedented numbers. About 60 million Americans went on-line to search for health and medical information in 1998, according to a study by Louis Harris & Associates. Another study, by Healtheon Corp., found that 85% of physicians use the Internet and a third communicate with patients via e-mail.

Yet Americans are also concerned about privacy and confidentiality. The site allows users the option of registering or remaining anonymous — and two-thirds chose not to register, even though the site ensures their privacy.

Essentially, this version of outcomes management involves a partnership between the physician and patient. Physicians who subscribe to the registry can arrange to have survey results sent directly to their electronic records database. They will be able to receive additional information, such as consistency scores, that show whether the patient gave consistent answers to the short series of questions and more detailed analysis of questions and answers. But patients must give permission first.

The Diamond Headache Clinic in Chicago is set up for the transmission of scores, which then become a part of the patient’s chart. But many patients choose to bring in their own reports, says associate director Merle Diamond, MD, FACEP. "Privacy is a big issue for patients," she says.

Feedback reports tell percentile

Yet beyond that hurdle of privacy, the interactive health assessment is a tool that helps patients define their symptoms and track their own progress. The brief feedback report tells patients their percentile ranking. For example, it will say that only four out of 10 people are more bothered by headaches than they are.

After taking a new medication, the patients can take the survey again and see how their percentile ranking has changed. The general health surveys give similar reports on overall physical and emotional health.

The interactive survey selects questions based on a person’s prior responses from a collection of dozens of possible items. For example, patients with mild headaches will receive questions geared toward that, while questions about the impact of severe symptoms would be eliminated. That provides the benefit of a long survey without the burden, explains Ware.

For headache sufferers, the DynHA gives expression to their symptoms, says Diamond. "We have a number of measures that are available to distinguish the most disabled patients," she says. "But for patients who are moderate or have episodic symptoms, we haven’t had a way to measure outcomes."

Patients now can take the health assessment as often as they like in the comfort of their own home. They become more involved in monitoring their health and treatment, says Diamond.

"I have patients coming in my office who say, "When I take my medicine this way, this is the result I get. When I don’t use it properly, I get these results,’" she says. "They can see little changes in efficacy."

Ultimately, making health assessment more accessible empowers patients, says Ware.

"We’re giving consumers proof that they do or don’t have substantial burden associated with their health problems," he says. "They can take that to their doctors and talk about it."