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Member Research and Reports

Member Research and Reports

Texas Researchers Find Primary Care Practices Lack Capacity to Implement Mandated Health Risk Assessments

A recent study reports on findings from a trial to test the feasibility of implementing “My Own Health Report,” (MOHR). MOHR is a new electronic or paper-based health behavior and mental health risk assessment and feedback system to support selective counseling and goal setting in primary care. The study, published in the November/December issue of Annals of Family Medicine, is titled, “Adoption, Reach, Implementation, and Maintenance of a Behavioral and Mental Health Assessment in Primary Care”, and was conducted by several researchers including Dr. Bijal A. Balasubramanian, who is assistant professor of epidemiology at The University of Texas Health Science Center at Houston (UTHealth) School of Public Health Dallas Regional Campus. Dr. Maria E. Fernandez also participated in the study. She is associate professor of health promotion and behavioral sciences and director of diversity programs at UTHealth School of Public Health at the Houston campus. The study was funded by the National Cancer Institute and included 18 primary care practices across the U.S.

Headshot 2014 w jacket cl - cropped - use this photo Dr. Bijal Balasubramanian web
[Photo: Dr. Maria E. Fernandez (left) and Dr. Bijal A. Balasubramanian]

Health risk assessments, now supported as part of the Medicare Annual Wellness Visit established by the Affordable Care Act, are important tools for understanding the frequency of behavioral risk factors that have implications for patients’ health and wellbeing. The brief, patient-centered MOHR tool, which is based on existing well-validated measures, provides immediate feedback to patients on their risk factors. It allows patients to identify and prioritize risk factors they are ready to change and want to discuss with their providers. It also includes a goal-setting worksheet to assist patients planning how to reduce risks. As part of the MOHR trial, researchers assessed how nine diverse primary care practices integrated MOHR into their workflows and also reported on the frequency of patient health risks, patients’ perceptions of importance, readiness to change and desire to discuss identified risks with providers.

Researchers found that although the primary care practices were willing to implement the behavior and mental health assessments, most lacked the capacity and infrastructure to do so without additional support once the trial ended. Researchers assessed how the practices integrated the MOHR into their workflows, what additional practice staff time it required and what percentage of patients completed the assessment. They found that most practices (60 percent) agreed to adopt MOHR, and half of the 3,591 patients who were approached completed the assessment. They found that reach varied by implementation strategy, with higher reach when MOHR was completed by staff, rather than by patients (71 percent vs. 30 percent). The observed reach of 50 percent was double the health risk assessment completion rates previously published by large health systems (22 percent) and on par with worksite completion rates coupled with economic incentives (40 to 64 percent).

The practices were successful in getting patients of all ethnic, racial and socio-economic levels to participate in MOHR. Analysis revealed that handling MOHR increased staff and clinician time an average of 28 minutes per visit. Consequently, no practices were able to sustain the complete MOHR assessment without adaptations after study completion. Researchers found most primary care practices are overwhelmed by competing demands, and typical office visits provide little time to address health risk information. Researchers assert that more substantial practice transformation will be necessary to integrate MOHR-like assessments routinely into primary care, and current incentives, such as the mandate to include health risk assessments as part of wellness care, are insufficient to facilitate this practice change. Merely mandating that health risk assessments be added to an already packed wellness visit, they conclude, simply increases the chances that practices will do it poorly or not at all.