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The short-term effect of patient health status assessment in a health maintenance organization

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This study was designed to test the short-term effects of health assessment on the process of care and patient satisfaction. The 29 Chart physicians used the Dartmouth COOP Charts to measure their adult patients' health status during a single clinical encounter; the 27 control clinicians used no measure of health status. We compared the change between baseline and post-intervention information for a sample of all study clinicians' patients. Most of the patients were female (67%), well educated (70% had at least a college education) and young (approximately 90% were aged 59 years or younger). We found that the ordering of tests and procedures for women was increased by exposure to the COOP Charts (52% vs. 35%; p<0.01); the effect in men was not as significant (37% vs. 23%: p=0.06). Although women reported no change in satisfaction with care, men claimed that the clinician helped in the management of pain (p=0.02). We conclude that the use of health status measures during a single clinical encounter in an HMO changes clinician test ordering behaviour and may improve the help male patients receive for pain conditions. The long-term impact of these management changes is not known.

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  1. Nelson EC, Landgraf JM, Hays RD, et al. The functional status of patients: how can it be measured in physicians' offices? Med Care 1990; 28: 1111–1126.

    Google Scholar 

  2. Rubenstein LZ. Geriatric assessment: an overview of its import. Clin Geriat Med 1987; 3: 1.

    Google Scholar 

  3. Rubenstein LZ, Josephson KR, Wieland GD, et al. Effectiveness of a geriatric evaluation unit. A randomized clinical trial. N Engl J Med 1984; 311: 1664–1670.

    Google Scholar 

  4. Hedriksen C, Land E, Stromgard E. Consequences of assessment and intervention among elderly people: a three-year randomized controlled trial. Br Med J (Clin Res) 1984; 289: 1522–1524.

    Google Scholar 

  5. Calkin DR, Rubenstein LV, Clearly PD, et al. The functional status questionnaire: initial results of a controlled trial. Clin Res 1986; 34(2): 359a.

    Google Scholar 

  6. Landgraf JM, Nelson EC, Hays RD, et al. Assessing function: does it really make a difference? A preliminary evaluation of the acceptability and utility of the COOP function charts. In Lipkin M., ed. Functional Status Measurement in Primary Care. New York: Springer-Verlag, 1990: 150–165.

    Google Scholar 

  7. German PS, Shapiro S, Skinner EA, et al. Detection and management of mental health problems of mental health patients by primary care screening. J. Am Med Assoc 1987; 257: 489.

    Google Scholar 

  8. Rubenstein LV, Calkins DR, Young RT, et al. Improving patient function: a randomized trial of functional disability screening. Ann Int Med 1989; 111: 836–842.

    Google Scholar 

  9. Nelson EC, Conger B, Douglass R, et al. Functional health status levels of primary care patients. J Am Med Assoc 1983; 249: 3337.

    Google Scholar 

  10. Stewart AL, Hays RD, Ware JE. The MOS shortform general health survey: reliability and validity in a patient population. Medical Care 1988; 26: 724–735.

    Google Scholar 

  11. Nelson EC, Berwick DM. The measurement of health status in clinical practice. Med Care 1989; 27: 577–590.

    Google Scholar 

  12. Lamberts H, Wood M. International Classification of Primary Care. Oxford: Oxford University Press, 1987.

    Google Scholar 

  13. Hays RD. The quality of patients' ratings: letter to the editor. Health Affairs 1988; 7: 174–175.

    Google Scholar 

  14. Hays RD, Hayashi T. Beyond internal consistency reliability: rationale and user's guide for multitrait scaling analysis program in the microcomputer. Behavior research methods, instruments and computers 1990; 22: 147–175.

    Google Scholar 

  15. Cronbach LJ. Coefficient alpha and the internal structure of tests. Biometrics 1951; 16: 297–334.

    Google Scholar 

  16. Steward AL, Greenfield S, Hays RD, et al. Functional status and well-being of patients with chronic conditions: results from the medical outcomes study. JAMA 1989; 262: 907–913.

    Google Scholar 

  17. Berwick DM. Continuous improvement as an ideal in health care. N Engl J Med 1989; 320: 53–56.

    Google Scholar 

  18. Wasson JH, Keller A, Rubenstein L, et al. Benefits and obstacles of health status assessment in ambulatory settings: the clinician's point of view. Medical Care 1992; (in press).

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This grant was supported by the henry J. Kaiser Family Foundation.

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Wasson, J., Hays, R., Rubenstein, L. et al. The short-term effect of patient health status assessment in a health maintenance organization. Qual Life Res 1, 99–106 (1992).

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