Healthy Living Messages

• Be Physically Active
• Eat Wisely
• Strive for a Healthy Weight
• Get Recommended Screening Tests & Immunizations
• Be Involved in Your Health Care
• Be Tobacco Free
• Limit Alcohol
• Manage Stress
• Be Safe
  

HealthPOWER! Prevention News - Spring 2010 (HRA)

Health Risk Assessment: A New Tool for VA
Linda Kinsinger, MD, MPH - Chief Consultant for Preventive Medicine
Leila C. Kahwati, MD, MPH - Deputy Chief Consultant for Preventive Medicine
Terri Murphy, RN, MSN - Program Manager for Prevention Policy 

Health risk assessments (HRAs) are tools that 1) systematically collect information from patients through the use of a structured questionnaire, tailored to each user as it is completed, and 2) provide information back to patients about the status of their health, with recommended steps to improve health. HRAs usually include questions about demographics, family history, lifestyle and health behaviors (such as tobacco use or physical activity), clinical preventive service needs, management needs for a limited number of common chronic conditions (such as diabetes and heart disease), health issues relevant to special populations (such as the elderly), and patients’ readiness to change selected health behaviors. As part of the VHA’s Preventive Care Program, an online HRA will be developed and hosted on the My HealtheVet web portal and will be electronically linked to VISTA/CPRS (Veterans Health Information Systems and Technology Architecture/Computerized Patient Record System). The National Center for Health Promotion and Disease Prevention (NCP), in collaboration with other VHA Program Offices, will be coordinating HRA development efforts. Despite several years of development work ahead of us, we are excited about building an HRA tool to serve as the foundation for future VHA health promotion/disease prevention services for Veterans.

HRAs provide benefits to Veterans by:

• Serving as a non-threatening way to provide sensitive personal data (such as sexual behavior) and receive information about health and health services;
• Creating an awareness of personal risk factors for chronic disease and injury;
• Empowering individuals with information about "do-able" actions to improve or maintain health;
• Allowing them to collaborate with their providers to set health-related goals and monitor progress; and
• Enhancing communication with their health care team members.

HRAs may also be helpful at the health care system level, by enabling systems to identify risks within a population (through better documentation of personal and family medical histories and risk factors), deliver follow-up interventions for those at risk, and track and analyze population health trends over time.

NCP is working to ensure that the HRA we develop for use within VHA will have the following components:

• A carefully constructed, dynamic set of initial questions, with further questions to probe into specific topics, depending on responses to initial questions;
• Algorithms that define risk status for a variety of conditions, based on responses to questions;
• Feedback algorithms that provide patients with appropriate information, based on patients’ risk and health status assessment;
• Bidirectional data flow with VISTA/CPRS, so that the assessment tool can be pre-populated with information already in VISTA/CPRS (e.g., birth date, last blood pressure, last cholesterol level, etc.) and information entered by the patient into the assessment tool can be sent to appropriate fields in CPRS (currently existing or to be added) and labeled as self-entered data;
• Patient reports that are simple, interesting, and provide health information written in an easily understandable way, and direct patients to recommended care; and
• Provider reports that summarize patient findings and recommended care in a brief format.

HRA items, risk scoring, and decision algorithms will be developed carefully and based on existing literature and evidence whenever possible. A workgroup is being convened to oversee content development and will include representatives from the field, VHA Central Office Programs, and subject matter experts. We will also ensure that the tool is written and designed appropriately for Veterans with low literacy.

Once both the content and the IT processes have been developed into a prototype, we will design a pilot program in several facilities to test implementation of the HRA. When it is ready for national implementation, we will provide guidance for use by patients and staff. Training plans for staff, and communication/marketing plans for patients, will also be developed. We expect that the facility Health Promotion and Disease Prevention Program Managers will play a key role in helping facilitate local processes for HRA implementation in terms of workflow and processes within the Patient-Centered Medical Home.

⇐Back to Table of Contents