Over half of all deaths before age 65 can now be attributed to lifestyle factors. In order to reduce the annual incidence of lifestyle-based causes of death, it is essential to understand the contribution of lifestyle factors that are potentially under the control of the individual and those that may be amenable to social, medical or pharmacological interventions. The health risk appraisal (HRA) can be an important tool in assessing the impact of these precursors of disease and trauma. Additionally, the 2009 National Committee for Quality Assurance (NCQA) release of their accreditation requirements for health plans, preferred provider organizations, managed care organizations and health and wellness promotion programs requires the administration of HRA's as part of the accreditation process. These new standards will stimulate broad utilization of the HRA and call for a systematic review/updating of currently available instruments. Similarly, the transformation of many primary care practices into patient centered medical homes will also stimulate the need for instruments and tools that can help facilitate provider-patient communication and patient education. However, little is known regarding the uptake, usability, acceptability and effectiveness of HRA's in diverse primary care settings. What information we do have is based on very few managed care settings, employer wellness programs and insurance plans among mostly white, middle-class, employed individuals. In short, there is no information, to our knowledge, regarding the use of HRA's among racial/ethnicity minority groups, the uninsured, the poor, or those with limited health literacy. We also know of no studies regarding provider or patient satisfaction with HRA's, yet alone the effects of HRA's on patient health outcomes or behavior/lifestyle changes. All of these are important research questions that need answered, but require one critically important tool-a proven HRA that is inexpensive and easy to field in a wide variety of primary care settings, some resource rich and others resource poor. This application is a first step in filling all of these knowledge gaps. To advance the science and knowledge regarding the use of HRA's in primary care clinical settings we propose the following aims:
Aim 1 : To re-engineer the Healthier People Network's Health Risk Appraisal (HPN-HRA) tool to a multi-platform, social-network-friendly, open-source code, and standards compliant software product, for use in the public domain either directly by users or indirectly by third-party applications via an Application Programmers Interface (API).
Aim 2 : To update current mortality risk algorithms, create new chronic disease and accidental death risk algorithms, and update the patient and provider reports in the HPN-HRA to provide estimates and recommendations based on systematic reviews of current scientific findings.
Aim 3 : To engage a local primary care practice based research network (PBRN) in the design and pilot testing of the new HRA as a prelude to a rigorous evaluation of the HRA in primary care to be carried out in a subsequent study.
Understanding the contribution of individual lifestyle factors amenable to social, psychological, medical or pharmacological interventions is essential to reducing morbidity and mortality. Health risk appraisals (HRA) have the potential to improve individual and population health outcomes by providing patients with important information on how lifestyle behaviors affect health and by providing administrative personnel and organizational providers with information regarding their patient populations that can facilitate provider/patient interactions and communication, needed preventive services and appropriate care for complex/chronic illnesses. We propose to re-engineer an existing HRA that will be a free-standing, open-source, public domain HRA engine based on the most up-to-date scientific data, and that will allow for easy scalability and interoperability with any number of other interfaces and systems, including websites (e.g., social media sites, clinic websites, etc.) and electronic medical record systems from different vendors.
