Health Assessments in Primary Care

How you use the information you gather depends on the type of information you collected, what you want to achieve, and what resources you have available. 

Did you tell your patients that you reviewed their health assessment?

An important first step is to tell patients you have reviewed the information. Regardless of how you choose to handle the information collected during health assessment, acknowledge to patients that you have reviewed the data you collected. Patients often wonder, "Why am I filling this out if the clinician isn't going to look at it?" Let them know you really do look at it. The acknowledgement can be brief: "Thank you, Ms. Jones, for filling out this questionnaire. It looks like you're having some minor symptoms of depression or stress, which we can talk about." Or, use the opportunity to deliver a focused reminder or praise about how a specific behavior affects a health concern of the patient. "It looks like you're doing a good job limiting your fatty foods and snacks. That can help keep your cholesterol at a healthy level. Keep it up."

When should your practice use the health assessment information?

Options for when to use the information include:

During the Visit

• Usually feasible for shorter health assessments.
• Can be done once a year during wellness visits.
• Ideally administered by practice staff with "flags" for clinicians.

Between Visits

• Better for longer assessments.
• Can be administered by any trained member of the health care team.
• Depending on results, may require additional follow-up visits with primary care clinician or other team member or referral to community-based services.

A Dedicated Health Assessment Visit

A more comprehensive health assessment could take an entire visit to complete and to review. For example, the Medicare Annual Wellness Visit (AWV) is designed to set aside time for a focused discussion with patients about their completed health assessment. A healthy elderly patient may identify no major health concerns, in which case the visit may take only 20 to 30 minutes. Alternatively, a patient may identify hearing loss, increased fall risk, depression, or previously unidentified chronic pain. Each of these concerns is potentially an issue that required comprehensive follow-up.

You will very likely have to bring the patient back for a separate visit in the event that you identify the patient to have a chronic disease. It is acceptable to bill for the AWV and to also bill the ICD-9 codes for the chronic disease diagnoses you evaluated and treated at the visit (e.g., hearing loss, falls/fall risk).

How is health assessment information used at the population or practice level? 

The above paragraphs address how the information is used with an individual patient. A related question is:How can health assessment data be used to improve the health of a population? The answer depends in part on the infrastructure available and how the information is to be used. If your health assessment includes questions about depression risk, you may be able to generate a list of patients who had a positive response on the depression questions, then review the list to determine who may require further follow-up. If a high percentage needs follow-up, it may be appropriate to develop a quality improvement activity to purposefully follow up with those patients.

An EHR may facilitate the collection and reporting of health assessment data at a population level. If the EHR does not have this functionality, you can manually review a random sample of patient charts (either electronic or paper) to evaluate assessment rates for conditions or risks your practice has determined are a high priority. Your practice may already have dedicated staff members working on this type of activity through PCMH or other quality reporting programs. 

There are also Web-based assessments available to primary care practices that—for a fee—will help manage health assessment data and provide reports. 

Appendix 3 and Appendix 6 are links to online assessment tools.