Session number: 1048
Abstract title: Routine Reporting of Health Status Data Does Not Improve General Health or Satisfaction
Author(s):
SD Fihn - VA Puget Sound Health Care System, HSR&D and University of Washington, Department of Medicine
MB McDonell - VA Puget Sound Health Care System, HSR&D
DH Au - VA Puget Sound Health Care System, HSR&D and University of Washington, Department of Medicine
M Burman - VA Puget Sound Health Care System, HSR&D and University of Washington, Department of Medicine
V Fan - VA Puget Sound Health Care System, HSR&D and University of Washington, Department of Medicine
P Diehr - VA Puget Sound Health Care System, HSR&D and University of Washington, Department of Biostatistics
Objectives: Prior studies of short-term feedback of general health status measures to providers have not improved patients’ overall health. We hypothesized that sustained reporting of general and condition-specific measures in a sophisticated graphical format would improve patients' health and satisfaction.
Methods: We conducted a group-randomized effectiveness trial in GIM clinics at 7 VA facilities with 2 or more discrete firms. All patients with a primary provider and an appointment in the last year were eligible. Respondents to a baseline health inventory were regularly mailed the SF-36, a patient satisfaction questionnaire, and, as relevant, validated questionnaires about 6 chronic conditions: coronary disease, COPD, depression, diabetes, alcohol use and hypertension. We computed SF-36 physical and mental component scales (PCS and MCS). Clinical data were retrieved from VistA. Data were graphically reported to providers of eligible patients at every visit for 2 years (e.g., blood pressure, HbA1C, SF-36 scale scores, anginal frequency) as well as “tips” derived from national guidelines. Clinicians received summaries comparing their panels with local/national norms and training on quality improvement and interpretation of health status measures.
Results: Of 34,103 eligible patients in an entry cohort, 22,223 returned baseline health inventories. Of these, 15,346 returned a subsequent mailing. Over 300,000 questionnaires were mailed, and over 44,000 feedback reports were distributed. After adjustment for baseline, mean changes in PCS and MCS scores over 2 years in intervention firms were not significantly different from controls (-7.28[sd 1.15] vs –6.63 [sd 1.04] and –3.63 [sd 1.43] vs. –3.83 [sd 1.71] , p >.10) in paired analyses. There were no significant differences in condition-specific health measures and satisfaction between groups after controlling for provider type, panel size, and number of visits or restriction to patients who completed all forms.
Conclusions: Routine collection and feedback of general and condition-specific measures of health and satisfaction did not improve outcomes. Such data should likely be linked to specific management suggestions if they are to improve patients’ outcomes.
Impact statement: Results should be highly valuable to individuals responsible for quality improvement in large health care systems, such as the VA, in planning and applying results of large-scale surveys.