Skip to main content

Main menu

  • Home
  • Content
    • Current Issue
    • Online First
    • Multimedia
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • The Issue in Brief (Plain Language Summaries)
  • Info for
    • Authors
    • Reviewers
    • Media
    • Job Seekers
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • RSS
    • Email Alerts
    • Journal Club
  • Contact
    • Feedback
    • Contact Us
  • Careers

User menu

  • My alerts

Search

  • Advanced search
Annals of Family Medicine
  • My alerts
Annals of Family Medicine

Advanced Search

  • Home
  • Content
    • Current Issue
    • Online First
    • Multimedia
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • The Issue in Brief (Plain Language Summaries)
  • Info for
    • Authors
    • Reviewers
    • Media
    • Job Seekers
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • RSS
    • Email Alerts
    • Journal Club
  • Contact
    • Feedback
    • Contact Us
  • Careers
  • Follow annalsfm on Twitter
  • Visit annalsfm on Facebook
Research ArticleInnovations in Primary Care

Using Patient-Entered Data to Supercharge Self-Management

Lynn Ho and Jean Antonucci
The Annals of Family Medicine July 2017, 15 (4) 382; DOI: https://doi.org/10.1370/afm.2068
Lynn Ho
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: nkfpdoc@gmail.com
Jean Antonucci
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • eLetters
  • PDF
Loading
  • patient self-efficacy
  • surveys and questionnaires
  • practice quality improvement

THE INNOVATION

Patients’ confidence in their ability to manage their own health conditions determines outcomes. We describe a low-burden method by which a practice of any size can measure and improve the health confidence of its population.

WHO & WHERE

We are solo family doctors who have been developing our own practice quality paradigms in low-overhead, technology-enabled, insurance-based outpatient practices in North Kingstown, Rhode Island, and Farmington, Maine, since 2004–2005.

HOW

Since 2006 our practices have been gathering patient-entered data using a free internet tool, http://www.howsyourhealth.org (Supplemental Appendix 1), to monitor and improve individual and practice-wide patient health confidence levels among other metrics. High levels of patient confidence are clearly shown to correlate with decreased harms and cost savings.1,2 Additionally, high levels of patient confidence are directly correlated with improved population health metrics.3

The online tool includes a single question about health confidence: “How confident are you that you can control and manage most of your health problems?” Patients can respond very, somewhat, or not confident. We ask patients to complete the online survey in preparation for or during their preventive care visits and receive each patient’s response via secure email before or during the visit, so we can address root causes for low confidence levels. For example, a common reason for low health confidence might be “I’ve tried, but haven’t been able to lose weight.” For such a reason, the response might involve running through a simple problem-solving algorithm (https://howsyourhealth.com/pblmslv/), which could leave the patient with a plan to change a component of eating behavior. Small, sequential successes in behavior change improve self-management ability and confidence.

When we ask patients to take the online survey, we give them a practice code to enter, and results of surveys that include our practice codes are continuously aggregated for the practices on a secure server at no cost to the practices. We can monitor the practice-wide level of confidence with self-management at baseline, implement a plan to improve confidence practice wide, and then check to see the effect of the intervention on patient confidence levels. Using repeated iterations of the above technique, one of us (L.H.) succeeded in increasing practice-wide very confident ratings from the national norm of 50% in 2006 to 69% in 2017. We have also used this continuously-aggregated, patient-entered health data to measure and then improve key primary care metrics such as continuity, efficiency, access, coordination and patient information (Supplemental Appendix 2).

LEARNING

Using patient-entered data to improve confidence in our practices has had 2 major effects. First, it has taught us that simple, low-cost, patient-centered methods exist for us and similar small practices to monitor and improve patient health confidence and other fundamental practice characteristics. Second, improvement of practice-wide health confidence has helped our practices better achieve health care’s triple aim: better population health, better patient experience, and lower monthly expenditures per patient. Two key differences distinguish this quality improvement innovation from de facto quality rating schemata based on EHR documentation: (1) metrics are 100% based on patient input, not derived from practice attestation; (2) this process is remarkably low in both administrative burden and cost for practices, since patients enter the data into an automatically aggregating free online tool (Supplemental Appendix 3). Unfortunately, despite the advantages and ease of use of this combined approach to measurement and improvement, we have encountered resistance from regional payers and quality organizations when suggesting the use of patient entered data for quality measurement. Primary care physicians are forced to spend too much time gathering and reporting quality data when tools like How’s Your Health? are available. We hope this article can spur uptake of this simple yet powerful method to measure quality and improve practice.

Footnotes

  • Conflicts of interest: authors report none.

  • Author affiliations, references, and 3 supplemental appendixes are available at http://www.annfammed.org/content/15/4/382/suppl/DC1.

  • © 2017 Annals of Family Medicine, Inc.
PreviousNext
Back to top

In this issue

The Annals of Family Medicine: 15 (4)
The Annals of Family Medicine
Vol. 15, Issue 4
July/August 2017
  • Table of Contents
  • Index by author
  • Back Matter (PDF)
  • Front Matter (PDF)
  • In Brief
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on Annals of Family Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Using Patient-Entered Data to Supercharge Self-Management
(Your Name) has sent you a message from Annals of Family Medicine
(Your Name) thought you would like to see the Annals of Family Medicine web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
9 + 2 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
Using Patient-Entered Data to Supercharge Self-Management
Lynn Ho, Jean Antonucci
The Annals of Family Medicine Jul 2017, 15 (4) 382; DOI: 10.1370/afm.2068

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Get Permissions
Share
Using Patient-Entered Data to Supercharge Self-Management
Lynn Ho, Jean Antonucci
The Annals of Family Medicine Jul 2017, 15 (4) 382; DOI: 10.1370/afm.2068
del.icio.us logo Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • THE INNOVATION
    • WHO & WHERE
    • HOW
    • LEARNING
    • Footnotes
  • Figures & Data
  • Info & Metrics
  • eLetters
  • PDF

Related Articles

  • PubMed
  • Google Scholar

Cited By...

  • In This Issue: Trends, Prescribing, Deprescribing
  • Google Scholar

More in this TOC Section

  • Long COVID Shared Medical Appointments: Lifestyle and Mind-Body Medicine With Peer Support
  • Adapting an In-Clinic Resource Navigator Program to a Virtual Referral Model
  • Connecting Group Care Patients to Mental Health and Food Resources During the COVID-19 Pandemic
Show more INNOVATIONS IN PRIMARY CARE

Similar Articles

Keywords

  • patient self-efficacy
  • surveys and questionnaires
  • practice quality improvement

Content

  • Current Issue
  • Past Issues
  • Past Issues in Brief
  • Multimedia
  • Articles by Type
  • Articles by Subject
  • Multimedia
  • Supplements
  • Online First

Info for

  • Authors
  • Reviewers
  • Media
  • Job Seekers

Engage

  • E-mail Alerts
  • e-Letters (Comments)
  • RSS
  • Journal Club
  • Submit a Manuscript
  • Subscribe
  • Family Medicine Careers

About

  • About Us
  • Editorial Board & Staff
  • Sponsoring Organizations
  • Copyrights & Permissions
  • Contact Us
  • eLetter/Comments Policy

© 2022 Annals of Family Medicine