Health Assessments in Primary Care

Obtaining periodic health assessments on patients provides an opportunity for primary care teams to get a snapshot on the health status and the health risks of empanelled patients. Health assessment is a process involving systematic collection and analysis of health-related information on patients for use by patients, clinicians, and health care teams to identify and support beneficial health behaviors and mutually work to direct changes in potentially harmful health behaviors. Health assessments are not intended to be diagnostic tools and they are not complete health histories; instead, they aim to be one method to engage patients in their own health, leading to better health choices and improved health behaviors in the long term.  

Much of the research on health assessments has focused primarily on their use and application in work settings. In these settings, successful use of health assessments requires assessments of health risks combined with health education programs. However, effective use of health assessments in primary care will require broader adoption and better implementation, including assessment, review, feedback and follow-up support for patients.

There are a variety of reasons to spark primary care practices to begin implementation of health assessments. For example, primary care practices may want to: 

1. Systemically identify health issues in their patients.
2. Take advantage of incentives provided by insurers or accrediting agencies.
3. Implement the Medicare Annual Wellness Visit (AWV).¹ 
4. Support national initiatives like the National Committee for Quality Assurance (NCQA) Patient Centered Medical Home (PCMH) Recognition Program and the Centers for Medicare & Medicaid Services meaningful use standards.² 

Thus, the purpose of this guide is to provide a framework and practical evidenced-based guidance for primary care teams to adopt and successfully implement health assessments in primary care practices.

Additional background information on health assessments can be found in Appendix 1.

Who Should Use This Guide?

This guide is designed to be used by a team of clinicians and staff in a practice. The guide can help:

• Practices with limited experience in implementing health assessments.
• Practices that have struggled with implementing health assessments in the past.
• Practices experienced in implementing health assessments.

Practices with extensive experience can benefit from this guide by reviewing key decision points and reminders about effective change strategies and processes.

How to Use This Guide

To use this guide effectively, first identify the health assessment "champion" or lead in your practice. The lead should:

• Review this entire guide to become familiar with its overall contents and process. Set aside a minimum of one hour for this task.
• Make notes in the guide for you and your team.
• Review the key decision points below.
• Seek guidance from the rest of your practice team.

Implementing a new health assessment effectively is not simply an "add-on" to the daily routine; it will have an impact on workflow, patient engagement, and office resources. Implementing health assessments is a process with "decision points" (shown below), from the early stages of health assessment selection and adoption to workflow integration through ongoing maintenance. For an example of the process, go to the brief Case Study in Appendix 2.

This guide provides guidance and tools for each of these decision points. The appendices provide additional resources—including specific health assessment questions you can review, modify, and use—and links to other sources. Look for the link to the appendix location. 

How Was This Guide Developed?

The content and recommendations in this guide follow from our observations and interviews with primary care providers, staff, and administrators conducted in two phases across four practice-based research networks. In phase one, we combined observational data from six primary care practices about how they have implemented health assessments with results from a literature review, LISTSERV^TM discussions, two patient advisory councils' recommendations, and expert panel recommendations. The combined results were used iteratively to develop a complete implementation guide. In phase two, the "How-To" Guide was field tested in another group of eight primary care practices. Observational data were again collected during the field test to further refine the content and organization of the guide based on user experiences.