Health Assessments in Primary Care: A How-to Guide

Section 2. How Does Your Practice Choose an Assessment?

A bar shows the sections of this guide as a series of questions: Section 2: 'How do you choose an assessment?' is highlighted.

Many health assessments are available, so the choice may seem overwhelming. Think about ways to start small by focusing on a specific group of patients. This section provides guidance on how to select a health assessment that is appropriate for your patient population and practice situation. The first step is to identify your practice's priorities in two areas: the type of patients you want to focus on and the health concerns you routinely discuss with those patients.

This is what [my staff] and I have talked about: "How do we want to do [our assessment]?" You've got to think about who you are going to [assess]; and then, you think about, "What are we going to do when we get the answers?" 

- Family nurse practitioner, rural private practice, Colorado

The following questions will help you select a health assessment while making sure the assessment you choose includes questions important to your practice.

1.  Which patient group is most important to your practice to begin assessing more routinely now?

  • ___ Adults.
  • ___ Seniors.
  • ___ Adolescents.
  • ___ Children.
  • ___ Other:  ___________________________________________________________________________________

2.  What specific health concerns do you want to more systematically ask the above patients about?

  • ___ Depression and anxiety.
  • ___ Healthy eating and physical activity.
  • ___ Social support or social isolation.
  • ___ Alcohol or substance abuse.
  • ___ Sexual activity.
  • ___ Tobacco or smoking.
  • ___ Personal safety.
  • ___ Pain.
  • ___ Confidence or ability to manage their own health.
  • ___ Quality of life.
  • ___ Other health behaviors, risks, or concerns: _______________________________________

    ___________________________________________________________________________________

3. What are your practice constraints in conducting health assessment?

Are you constrained by any of the following factors?

  • ___ The time required for you and your staff to conduct the assessment(s).
  • ___ The potential for reimbursement.
  • ___ The health risk questions already in your electronic medical record.
  • ___ Other quality improvement initiatives that may be ongoing within your practice:

    ___________________________________________________________________________________

    ___________________________________________________________________________________

4.  How will you and your health care team act on the results of health assessment?   

When thinking about the types of questions you may ask, you must consider how your team will act on the results.

  • What resources does your practice have to follow up and treat conditions identified by the assessment?  
  • Which care team members can help to identify resources for patients for specific health concerns?

The work of addressing risks identified on a health assessment does not have to fall entirely on clinicians or practice staff. Community and online resources may be available to help activate and engage patients with addressing behaviors such as smoking or weight loss.

  • Which resources outside the office can your practice connect patients to (e.g., community or Web-based resources)?
  • How else can your practice staff activate and engage patients when a health concern has been identified (e.g., motivational interviewing techniques, protocols for planned follow up)?

After answering the above questions, you should now have a good idea of the type of assessment you want to implement. The next step is to determine the exact assessment to conduct in your practice. The Appendixes contain many types of sample questions and additional resource links.

  • Appendix 3: Adult health assessment resources. 
  • Appendix 4: Sample questions for adult health assessments. 
  • Appendix 5: Child health assessment resources.
  • Appendix 6: Adolescent health assessment resources. 
  • Appendix 7: Information about the Annual Wellness Visit and assessments for seniors. 

You don't want to ask questions if you're not prepared to address them; that is, don't ask if you won't review and act on it, especially if you lack the resources to address the problem. 

We ask about violence in our preventive care question set. Although positives are uncommon, we recently did catch one instance of domestic violence that we were able to address that we wouldn't have caught otherwise 

-Family physician, suburban private practice, New Jersey

 

Are you already collecting this information?

Several quality improvement or recognition programs require documenting or reporting specific information about your patients. Some of the items required may contain elements of health assessments, though they are often incomplete. Here are some common programs in primary care and their related health assessment items.

Table 2: Health Assessments Related to Incentive and Quality Programs

Compre-
hensive Health Assessment Items
CMS
Medicare
Annual
Wellness Visit
CMS
Meaningful Use -
Stage 1
NCQA HEDIS
Measures
2012
NCQA PCMHa
2011
PQRS
Measures
2011
The Joint Commission Core Measure SetsUSPSTF
"A" or "B"
Grade Recs

Alcohol Use

X  XXXXb

Depression

X  X Xb Xb

Fall Risk

X Xc X  

Physical
Activity

X Xc    

Tobacco Use

XXb XXbXXb

a. PCMH: Requirement 2C Comprehensive Health Assessment includes "Behaviors affecting health."
b. Includes assessment and follow-up action (e.g., referral, counseling, other intervention).
c. Medicare patients only.

A complete crosswalk can be found in Appendix 8

If you are already using a health assessment in your practice, like those listed in the table above, you may find you can augment it with a specific health assessment tool to conduct a full health assessment with your patients.

Current as of September 2013
Internet Citation: Health Assessments in Primary Care: A How-to Guide: Section 2. How Does Your Practice Choose an Assessment?. September 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/prevention-chronic-care/improve/system/health-assessments/health-assessment2.html