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My Own Health Report (MOHR) Project
(Previously PRO Project)
Goal: Integrate Patient Reported Behavioral Health Domains into
Routine Primary Care Practice
Roshan Bastani, PhD, Beth Glenn, PhD,
Russ Glasgow, PhD
CPCRN Spring Virtual Meeting
April 15, 2013
Patient-Reported Behavioral Health Domains
Domain
1.Demographics
Final Measure (Source)
9 items: Sex, date of birth, race, ethnicity, English fluency, occupation, household
income, marital status, education, address, insurance status, veteran’s status.
Multiple sources including: Census Bureau, IOM, and National Health Interview
Survey (NHIS)
2. Overall Health Status 1 item: BRFSS Questionnaire
3. Eating Patterns
3 items: Modified from Starting the Conversation (STC).
(Adapted from Paxton, AE et al. Am J Prev Med, 2011; 40(1):67-71.)
4. Physical Activity
2 items: The Exercise Vital Sign (Sallis, R. Br J Sports Med 2011; 45(6):473–474)
5. Stress
1 item: Distress Thermometer (Roth AJ, et al. Cancer 1998; 15(82):1904-1908.)
6. Anxiety and
Depression
4 items: Patient Health Questionnaire - Depression & Anxiety (PHQ-4)
(Kroenke K, et al. Psychosomatics 2009; 50(6):613-621.)
7. Sleep
2 items: a. Adapted from BRFSS
b. Neuro-QOL (Item PQSLP04)
2 items: Tobacco Use Screener (Adapted from YRBSS Questionnaire)
8. Smoking/ Tobacco
Use
9. Risky Drinking
10. Substance Use
1 item: Alcohol Use Screener (Smith PC, et al. J Gen Intern Med 2009; 24(7):783-788)
1 item: NIDA Quick Screen (Smith PC, et al. Arch Intern Med 2010, 170(13): 11551160.)
Background
Round 1 of Funding to UCLA
Step 1: Key Informant Interviews
Solicited input from clinic leaders/staff regarding implementation of PRO measure within
workflow
Participants represented 4 FQHCs in CA and partner clinics in Virginia, Vermont, and
Massachusetts
Results suggested high interest among providers but concerns about duplication of data
collection and added time and cost burden
Step 2: Paper and Pencil Implementation of PRO Measure
Participating clinics implemented measure with N = ≥ 50 patients plus post-implementation
key informant interviews and brief patient survey
Majority of patients “screened positive” for multiple domains
Clinic follow-up of identified concerns varied widely
Patients had few difficulties or complaints about measure itself
Round 2 of Funding: Nine Sites Funded (5 PBRN; 4 FQHC)
Name change: My Own Health Report (MOHR)
Pragmatic Trial
– Cluster randomized trial of 9 pairs of clinics (5 PBRN; 4 FQHC)
– Study was designed to maximize flexibility and adoption (e.g.,
clinics with different levels of HIT use, experience with QI)
– Standard delivery of automated assessment tool, feedback, goal
setting materials, and suggestions for follow-up
– Delivery of these components is customized to each setting
– Study goal: sustainable, routine
implementation of MOHR
assessment and intervention
VT
1 PBRN
VA
3 PBRNs
NC
1 FQHC
CA
1 PBRN
1 FQHC
TX
2 FQHCs
Pragmatic Features
Relevant
Diverse, real-world primary care settings; and
staff who do all the intervention
Rigorous
Cluster randomized, delayed intervention design
Rapid
One year from concept, planning, and Execution
Low Cost and Cost informative
Transparent
Report on adaptations, failures, lessons learned
Design of Pragmatic Trial
Early Implementation Sites (4 FQHC, 5 PBRN)
Intervention
(Provider & Patient
Feedback Reports + F. U)
Patient
Experiences
Survey (n = 300)
MOHR Assessment
(all non-acute adult visits for 3-4
months, n = ~300)
2nd
Optional:
MOHR Assessment
(only for those who completed MOHR)
Delayed Implementation Sites (4 FQHC, 5 PBRN)
Intervention
(Provider & Patient
Feedback Reports + F. U)
Arrow =
between group
comparison
Months 0
Patient
Experiences
Survey (n = 300)
1
2
3
4
5
6
Implementation of
MOHR Tool
7
8
9
10
11
12
MOHR Online Assessment Tool:
Developed by Alex Krist (VCU)
(Transfer of “co-ordinating center” from UCLA to VCU)
Features:
Health Risk Assessment (13 domains)
Solicitation of Patient Priorities
– e.g., ready to change; want to discuss with doctor
Patient Health Summary Report
– e.g., things they are doing well; areas for improvement
Online Access to Patient Summaries
– Can look up specific patients
Online Tracking of Implementation Progress across Sites
– e.g., number of patients that were screened, % screened + for specific
domains
Screenshots from MOHR
Online Assessment Tool
Health Risk Assessment
Soliciting Patient Priorities
Soliciting Patient Priorities
Patient Health Summary Report
Access to Patient Summaries
Online Tracking of Implementation Progress
Design of Pragmatic Trial
Early Implementation Sites (4 FQHC, 5 PBRN)
Intervention
(Provider & Patient
Feedback Reports + F. U)
Patient
Experiences
Survey (n = 300)
MOHR Assessment
(all non-acute adult visits for 3-4
months, n = ~300)
2nd
Optional:
MOHR Assessment
(only for those who completed MOHR)
Delayed Implementation Sites (4 FQHC, 5 PBRN)
Intervention
(Provider & Patient
Feedback Reports + F. U)
Arrow =
between group
comparison
Months 0
Patient
Experiences
Survey (n = 300)
1
2
3
4
5
6
Implementation of
MOHR Tool
7
8
9
10
11
12
Patient Experience Survey (PES)
20 item survey to be administered 2-8 weeks post-visit
Eligibility for PES: all patients reporting for non-acute care visits
during implementation period for both clinics within each pair
(regardless of MOHR use)
The PES assesses patient perceptions regarding:
– Assessment of the specific health behavior and psychological domains
related to recent clinic visit
– Collaborative goal-setting within each domain
– Clinic/provider follow-up for each domain
– Quality of clinic/provider communication
– Patient-centeredness of care provided by their clinic
Context & Cost Assessments
Goals of Contextual Assessment
To identify and describe contextual phenomena that may impact MOHR
implementation
To provide information on external validity and factors important for
transferring MOHR to other settings
Goals of Cost Assessment
To assess clinic resources & time needed to implement MOHR
To provide information to practices considering MOHR implementation as well
as to funding agencies and payers
Study Outcomes Summary
• Between group comparison
– Patient Experiences Survey
• Within group implementation outcomes:
– REACH: % eligible patients completing the health assessment
– Follow-up health assessment: only for patients who complete
online and provide email address
– Contextual assessment
– Cost assessment