Frequency and Prioritization of Patient Health Risks from a Structured Health Risk Assessment

I write this commentary from two interwoven perspectives. I have been a health psychologist practicing in primary care practices and health care organizations for 30 years. Across those clinical settings, I have challenged the separation between the organization/delivery of primary care and the delivery of health psychology. Also I have been fortunate to be a contributing part of the MOHR group, participating in data collection at two non-research based family medicine sites and participating in the interpretation and discussion of the data.

From those perspectives, I can respond to two crucial questions and identify at least two other questions that remain, if the real potential of the MOHR is to be recognized.

Unquestionably, health risk assessment can be done in the everyday flow of primary care. In diverse sites, with diverse clinical populations, using often modest resources, primary care practices have used the MOHR to collect behavioral data from patients. Furthermore, the patients were able to prioritize areas for change, the practices were able to incorporate the data provided, and patients and physicians were able to discuss the outcomes in follow-up visits.

Data collection for the MOHR project began in March 2013 and its results are now published.[1] Peek et al, challenged our field's research paradigm to conduct research that (1) is relevant to stakeholders; (2) is rapid and recursive in application; (3) redefines rigor; (4) reports on resources required; and (5) is replicable.[2]

That the MOHR project meets those criteria is doubly impressive: important usable data were generated that enhanced patient activation and care. In addition, the MOHR project demonstrated that research can be done on the ground in extremely challenging circumstances.

There are outstanding issues. Data were summarized for provider use via fax. In paperless offices more and more dependent on EHR's, the mode of health data delivery must be integrated with the patient's electronic chart.

Last, the functions related to the MOHR need to be integrated into the information management function of practices: analysis, EHR assisted care plans, and reports on relevant Meaningful Use patient outcomes. These functions must and can be part of the normal flow of the work of primary care. That work is in process at the University of Vermont.

Setting aside those perspectives and new questions, the paper summarizes important efforts, demonstrates that behavioral care can indeed be part of the transformation of primary care, and leaves me very excited about the next steps.

1. Krist A, Phillips S, Sabo R, Balasubramanian B, Heurtin-Roberts S, Ory M, Johnson S, Sheinfeld-Gorin S, Estabrooks P, Ritzwoller D, Glasgow R, and the Mohr Group. Adoption, Reach, Implementation, and Maintenance of a Behavioral and Mental Health Assessment in Primary Care. Ann Fam Med. 2014; 12(6):525-533.

2. Peek CJ, Glasgow R., Stange K, Kledges L, Kessler R. The Five R's: An Emerging Bold Standard for Conducting Relevant Research in a Changing World. Ann Fam Med. Sep/Oct 2014; 12(5):447-455. doi: 10.1370/afm.1688

Competing interests: None declared