This work examines the association between hypertension and hypothyroidism in geriatric patients seen at a primary care medical office. One hundred and twentytwo geriatric patients with elevated thyroid stimulating hormone (TSH) levels were selected for the study. An equal number of euthyroid geriatric individuals were selected from the same clinic for comparison. We found no differences in mean diastolic blood pressure (DBP) in the euthyroid and hypothyroid groups (80.1 mm Hg vs 78.9 mm Hg, P = 0.25). Additionally, there was no significant association between having hypertension

SummaryObjectives: Various computerized health risk appraisals (HRAs) are available, but few of them assess health-related quality of life (HRQoL) in a goal-directed framework. This study describes the user-centered development and usability testing of an innovative HRQoL module that extends a validated HRA tool in primary care settings. Methods: Systematic user-centered design, usability testing, and qualitative methods were used to develop the HRQoL module in primary care practices. Twenty two patients and 5 clinicians participated in two rounds of interactive technology think-out-loud sessions (TOLs) and semi-structured interviews (SSIs) to iteratively develop a four-step, computerized process that collects information on patient goals for meaningful life activities and current level of disability and presents a personalized and prioritized list of preventive recommendations linked to online resources. Results: Analysis of TOLs and SSIs generated 5 categories and 11 sub-categories related to facilitators and barriers to usability and human-technology interaction. The categories included: Understanding the Purpose, Usability, Perceived Value, Literacy, and Participant Motivation. Some categories were inter-connected. The technology was continually and iteratively improved between sessions until saturation of positive feedback was achieved in 4 categories (addressing motivation will require more research). Usability of all screen units of the module was improved substantially. Clinician feedback emphasized the importance of the module's ability to translate the patient-centered HRQoL Report into actionable items for clinicians to facilitate shared decision-making. Complete integration of the HRQoL module into the existing HRA will require further development and testing. Conclusions: Systematic application of user-centered design and human factors principles in technology development and testing may significantly improve the usability and clinical value of health information systems. This more sophisticated approach helped us translate complex clinical concepts, goal-setting steps, and decision-support processes into an accepted and value-added technology. BackgroundThe Patient Protection and Affordable Care Act (ACA) was introduced in 2010 and it aimed at improving the quality and affordability of healthcare for Americans. It also established new benefits for annual wellness visits (AWVs) for Medicare beneficiaries. In response, the Centers for Medicare and Medicaid Services (CMS) instituted billing codes for a "Welcome to Medicare" and annual follow-up visits to create and maintain a personalized wellness plan [1]. The regulation stipulated that as part of the AWV, an annual health risk assessment (HRA) must be performed. CMS also prescribed an HRA minimum dataset that must cover demographics, biometrics, self-assessed health status, psychosocial health, behavioral health, and functioning that include memory, activities of daily living (ADLs) and instrumental activities of daily living (IADLs) [2].Several sy...