Real-World Implementation and Outcomes of Health Behavior and Mental Health Assessment

Abstract

Background Assessing patient-reported health behaviors is a critical first step to prioritizing prevention in primary care. We assessed the feasibility of point-of-care behavioral health assessment in nine diverse primary care practices, including four federally-qualified health centers (FQHCs), four Practice-based Research Network (PBRN) practices, and a Department of Veterans Affairs (VA) practice. Methods In this prospective mixed-methods study, practices were asked to integrate a standardized paper-based health behavior and mental health assessment into their workflow for 50 or more patients. We used three data sources to examine the implementation process: 1) patient responses to the health assessment, 2) patient feedback surveys about how assessments were used during encounters, and 3) post-implementation interviews. Results Most (71%) non-urgent patients visiting the participating practices during the implementation period completed the health assessment, but reach varied by practice (range: 59-88%). Unhealthy diet, sedentary lifestyle, and stress were the most common patient problems with similar frequencies observed across practices. The median number of “positive screens” per patient was similar across FQHCs (3.7-positives, SD=1.8), PBRN practices (3.8-positives, SD=1.9), and the VA clinic (4.1-positives, SD=2.0). Primary care clinicians discussed assessment results with patients about half of the time (54%), with considerable between practice variation (range: 13%-66% with lowest use among FQHC clinicians). Although clinicians were interested in routinely implementing assessments, many reported not feeling confident of having resources or support to address all patients’ behavioral health needs. Conclusions Primary care practices will need to revamp their patient-reported data collection processes in order to integrate routine health behavior assessments. Implementation support will be required if health assessments are to be actively used as part of routine primary care.

Linking Data From Health Surveys and Electronic Health Records: A Demonstration Project in Two Chicago Health Center Clinics

“…Generally, our concordance findings were consistent with studies that have used similar methods ( 7 , 25 , 26 ). Our level of agreement was similar to previous research assessing data quality between ambulatory medical record data and patient survey data for diabetes and BMI, but we had a higher level of concordance for HBP, HBP medication, and hyperlipidemia and a lower level of concordance for lipid-lowering medication ( 26 ).…”

Adoption, Reach, Implementation, and Maintenance of a Behavioral and Mental Health Assessment in Primary Care

“…Study methods and pilot data have been reported previously. 16,17 The study was approved by the Virginia Commonwealth University (VCU) (#HM12746), (#12-0017900), and 5 other participating institutional review boards. …”

Retrospective Demographic Analysis of Patients Seeking Care at a Free University Chiropractic Clinic

“…However, the use of valid and reliable assessment tools to collect self-reported data on smoking, drinking, and exercise behaviors in primary care settings remains challenging. [36][37][38] The majority of referrals were self-referrals, friends and family, and medical in origin. The determinants of self-referrals to chiropractic physicians include patient attitudes, better health status, and affordable costs.…”