Adoption, reach, implementation, and maintenance of a behavioral and mental health assessment in primarycare.

Krist AH1, Phillips SM2, Sabo RT2, Balasubramanian BA2, Heurtin-Roberts S2, Ory MG2, Johnson SB2, Sheinfeld-Gorin SN2, Estabrooks PA2, Ritzwoller DP2,Glasgow RE2; MOHR Study Group.

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Abstract

PURPOSE:

Guidelines recommend screening patients for unhealthy behaviors and mental health concerns. Health risk assessments can systematically identify patient needs and trigger care. This study seeks to evaluate whether primary care practices can routinely implement such assessments into routine care.

METHODS:

As part of a cluster-randomized pragmatic trial, 9 diverse primary care practices implemented My Own Health Report (MOHR)-an electronic or paper-based health behavior and mental health assessment and feedback system paired with counseling and goal setting. We observed how practices integrated MOHR into their workflows, what additional practice staff time it required, and what percentage of patients completed a MOHR assessment (Reach).

RESULTS:

Most practices approached (60%) agreed to adopt MOHR. How they implemented MOHR depended on practice resources, informatics capacity, and patient characteristics. Three practices mailed patients invitations to complete MOHR on the Web, 1 called patients and completed MOHR over the telephone, 1 had patients complete MOHR on paper in the office, and 4 had staff help patients complete MOHR on the Web in the office. Overall, 3,591 patients were approached and 1,782 completed MOHR (Reach = 49.6%). Reach varied by implementation strategy with higherreach when MOHR was completed by staff than by patients (71.2% vs 30.2%, P <.001). No practices were able to sustain the complete MOHRassessment without adaptations after study completion. Fielding MOHR increased staff and clinician time an average of 28 minutes per visit.

CONCLUSIONS:

Primary care practices can implement health behavior and mental health assessments, but counseling patients effectively requires effort. Practices will need more support to implement and sustain assessments.