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Wasson JH. A "What Matters Index" (WMI) for Adolescents. J Ambul Care Manage 2023; 46:121-126. [PMID: 36662156 PMCID: PMC9946159 DOI: 10.1097/jac.0000000000000456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A "What Matters Index" (WMI) represents the distillation of many self-reported measures about what matters. The WMI for adults contains only 5 items that efficiently identify important needs, reliably identify people at risk for future problems, and provide guidance for improving health care and well-being. This report uses data from 10 000 respondents to illustrate the value of a 3-item WMI for adolescents built on the model of the Adult WMI.
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Wasson JH. Standardized assessment, information, and networking technologies (SAINTs): lessons from three decades of development and testing. Qual Life Res 2021; 30:3145-3155. [PMID: 32451982 PMCID: PMC8528738 DOI: 10.1007/s11136-020-02528-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2020] [Indexed: 10/27/2022]
Abstract
PURPOSE To rectify the significant mismatch observed between what matters to patients and what clinicians know, our research group developed a standardized assessment, information, and networking technology (SAINT). METHODS Controlled trials and field tests involving more than 230,000 adults identified characteristics of a successful SAINT- www.HowsYourHealth.org -for primary care and community settings. RESULTS Evidence supports SAINT effectiveness when the SAINT has a simple design that provides a service to patients and explicitly engages them in an information and communication network with their clinicians. This service orientation requires that an effective SAINT deliver easily interpretable patient reports that immediately guide provider actions. For example, our SAINT tracks patient-reported confidence that they can self-manage health problems, and providers can immediately act on patients' verbatim descriptions of what they want or need to become more health confident. This information also supports current and future resource planning, and thereby fulfills another characteristic of a successful SAINT: contributing to health care reliability. Lastly, SAINTs must manage or evade the "C-monsters," powerful obstacles to implementation that largely revolve around control and commercialism. Responses from more than 10,000 adult patients with diabetes illustrate how a successful SAINT offers a standard and expedient guide to managing each patient's concerns and adjusting health services to better meet the needs of any large patient population. CONCLUSION Technologies that evolve to include the characteristics described here will deliver more effective tools for patients, providers, payers, and policymakers and give patients control over sharing their data with those who need it in real time.
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Goodlin SJ, Jette AM, Lynn J, Wasson JH. Community Physicians Describe Management Issues for Patients Expected to Live Less than Twelve Months. J Palliat Care 2019. [DOI: 10.1177/082585979801400106] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We examine management issues experienced by community physicians providing care to patients they expect to die within a year. In a case series, 61 physicians in northern New England enrolled 182 consecutive dying patients. Important management issues for these patients were recorded at enrollment and eight months later. The patients’ average age was 74 years; most had cancer (48%) or cardiovascular disease (38%). Almost two-thirds of the patients died within eight months of enrollment. Major management issues for the physicians in care of these patients were deficits in basic self-care, emotional support, pain control, and nutrition. Pain control and family need for support were reported most frequently. Although demand for physician time was seldom a major management issue, when it occurred it correlated with patients’ emotional needs or their desire to extend life (p<0.01). Two barriers to optimum care commonly cited by physicians were (a) the differences in treatment expectations between family members, patients, and physicians and (b) the incurable, progressive nature of the patients’ diseases. Efforts to improve care for patients who have limited life expectancy should further explore the perceptions of community physicians.
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Wasson JH. Impact of Primary Care Intensive Management on High-Risk Veterans' Costs and Utilization. Ann Intern Med 2018; 169:514. [PMID: 30285200 DOI: 10.7326/l18-0460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Wasson JH, Ho L, Soloway L, Moore LG. Validation of the What Matters Index: A brief, patient-reported index that guides care for chronic conditions and can substitute for computer-generated risk models. PLoS One 2018; 13:e0192475. [PMID: 29470544 PMCID: PMC5823367 DOI: 10.1371/journal.pone.0192475] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 01/24/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Current health care delivery relies on complex, computer-generated risk models constructed from insurance claims and medical record data. However, these models produce inaccurate predictions of risk levels for individual patients, do not explicitly guide care, and undermine health management investments in many patients at lesser risk. Therefore, this study prospectively validates a concise patient-reported risk assessment that addresses these inadequacies of computer-generated risk models. METHODS Five measures with well-documented impacts on the use of health services are summed to create a "What Matters Index." These measures are: 1) insufficient confidence to self-manage health problems, 2) pain, 3) bothersome emotions, 4) polypharmacy, and 5) adverse medication effects. We compare the sensitivity and predictive values of this index with two representative risk models in a population of 8619 Medicaid recipients. RESULTS The patient-reported "What Matters Index" and the conventional risk models are found to exhibit similar sensitivities and predictive values for subsequent hospital or emergency room use. The "What Matters Index" is also reliable: akin to its performance during development, for patients with index scores of 1, 2, and ≥3, the odds ratios (with 95% confidence intervals) for subsequent hospitalization within 1 year, relative to patients with a score of 0, are 1.3 (1.1-1.6), 2.0 (1.6-2.4), and 3.4 (2.9-4.0), respectively; for emergency room use, the corresponding odds ratios are 1.3 (1.1-1.4), 1.9 (1.6-2.1), and 2.9 (2.6-3.3). Similar findings were replicated among smaller populations of 1061 mostly older patients from nine private practices and 4428 Medicaid patients without chronic conditions. SUMMARY In contrast to complex computer-generated risk models, the brief patient-reported "What Matters Index" immediately and unambiguously identifies fundamental, remediable needs for each patient and more sensibly directs the delivery of services to patient categories based on their risk for subsequent costly care.
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Wasson JH, Soloway L, Moore LG, Labrec P, Ho L. Development of a care guidance index based on what matters to patients. Qual Life Res 2017; 27:51-58. [DOI: 10.1007/s11136-017-1573-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2017] [Indexed: 12/15/2022]
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Fortinsky RH, Wasson JH. How do physicians diagnose dementia? Evidence from clinical vignette responses. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/153331759701200202] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examined how a sample of family practitioners, general internists, and osteopathic physicians practicing in the state of Maine (N=353) diagnose symptoms of cognitive dysfunction. Physicians' reported diagnostic approaches were compared to American and Canadian expert panel recommendations, and were associated with their sociodemographic and office practice characteristics. Sample members responded to a self-administered questionnaire, which was completed in response to a clinical vignette describing a patient with either mild symptoms or more progressive symptoms of cognitive dysfunction. Results showed that 59 percent of respondents would perform a formal cognitive status test and 32 percent would perform a depression screening test; both types of tests are recommended by American and Canadian expert panels. Adjusting for other factors, female physicians were twice as likely as males to perform a depression screening test (OR=2.04; 95 percent C1=1.13-3.67). Most respondents (87 percent) would order at least three of four recommended laboratory tests, and 59 percent would order a computerized tomography (CT) scan, even though expert guidelines are ambiguous about the value of CT scans in diagnostic workups. Diagnostic approaches were not significantly affected by plans to refer patients to other physicians for additional testing. Practicing physicians should be encouraged to perform recommended nueropsychological and mental status tests when patients present with symptoms of cognitive dysfunction.
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Fortinsky RH, Leighton A, Wasson JH. Primary Care Physicians' Diagnostic, Management, and Referral Practices for Older Persons and Families Affected by Dementia. Res Aging 2016. [DOI: 10.1177/0164027595172002] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
As the size of the older population increases, primary care physicians can expect to see growing numbers of patients who present with symptoms of cognitive dysfunction. This study examines how office-based primary care physicians in three states (N = 498) diagnose and manage dementia symptoms using clinical vignettes portraying a 72-year-old woman with either mild or moderate dementia symptoms and her adult daughter. Physicians were more likely to order a variety of laboratory tests than to perform mental and cognitive status tests as part of a diagnostic workup. Respondents also were much more likely to disclose a diagnosis of probable Alzheimer's disease to the daughter in the vignette than to her mother. Differences in reported dementia management behaviors were found according to physician specialty, number of years in practice, and experience with patients with dementia in actual practice. Results suggest that whereas primary care physicians can play a valuable role in the service system for families affected by dementia, barriers must be overcome to improve specific aspects of their diagnostic and management behaviors.
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Wasson JH, Ho L. Snapshots of Patient Engagement in Practice Improvement. J Ambul Care Manage 2013. [DOI: 10.1097/jac.0b013e318299dace] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kilo CM, Wasson JH. Practice redesign and the patient-centered medical home: history, promises, and challenges. Health Aff (Millwood) 2013; 29:773-8. [PMID: 20439860 DOI: 10.1377/hlthaff.2010.0012] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Medical practice redesign refers to the intentional efforts to improve practice processes and outcomes. Efforts to redesign office-based medical care go back some forty years. We divide the history of practice redesign into three overlapping phases: basic investigation, model development, and dissemination. The "medical home" movement in primary care has accelerated this dissemination phase. The acceleration and scaling up of efforts in practice redesign that have resulted from interest in the medical home present substantial opportunities and challenges for the medical profession and the U.S. health care system. We review the history and extract lessons to inform today's medical practice redesign efforts.
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Karagas MR, Wasson JH. A World Wide Web-based survey of nonmedical tattooing in the United States. J Am Acad Dermatol 2012; 66:e13-4. [PMID: 22177648 DOI: 10.1016/j.jaad.2010.11.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Revised: 10/19/2010] [Accepted: 11/11/2010] [Indexed: 11/17/2022]
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Nelson EC, Godfrey MM, Batalden PB, Berry SA, Bothe AE, McKinley KE, Melin CN, Muething SE, Moore LG, Nolan TW, Wasson JH. Clinical Microsystems, Part 1. The Building Blocks of Health Systems. Jt Comm J Qual Patient Saf 2008; 34:367-78. [DOI: 10.1016/s1553-7250(08)34047-1] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
With ever increasing pressure on doctors’ time, Iona Heath (doi: 10.1136/bmj.39532.671319.94) wonders whether primary care really meets the needs of elderly people at all, while John Wasson suggests ways for doctors to improve the care of older patients that don’t require extra resources or staffing
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Thoma JB, Wasson JH. Show me the way--health care innovation in the heartland. MISSOURI MEDICINE 2008; 105:111-113. [PMID: 18453187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Moore LG, Wasson JH. The ideal medical practice model: improving efficiency, quality and the doctor-patient relationship. FAMILY PRACTICE MANAGEMENT 2007; 14:20-4. [PMID: 17912818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
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Wasson JH, MacKenzie TA, Hall M. Patients use an internet technology to report when things go wrong. Qual Saf Health Care 2007; 16:213-5. [PMID: 17545349 PMCID: PMC2465004 DOI: 10.1136/qshc.2006.019810] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2007] [Indexed: 01/02/2023]
Abstract
BACKGROUND As patients directly experience harm from adverse events, investigators have proposed patient-report to complement professional reporting of adverse events. OBJECTIVE To investigate how an automated health assessment system can be used to identify adverse events. DESIGN AND SETTING Internet survey responses from April 2003 to April 2005 involving communities and clinical practices across the USA. PATIENTS 44,860 adults aged 19-69 years. OUTCOME Patient perceptions of adverse events experienced during the previous year. Independent legal review was also used to estimate how many patient-reports were serious enough to be potentially compensable. RESULTS Although patient reports of possible adverse events was low (1.4%), the percentage of adverse events was eight times higher for patients with the greatest burden of illness than for those with the least (3.4% vs 0.4%). Two expert malpractice attorneys agreed that 9% of the adverse events seemed to be serious. CONCLUSIONS PATIENTS will use internet technology to report their perceptions of health-related adverse events. Some of the patient-reported events reported will be serious.
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Abstract
"Patient-centered, collaborative care" is healthcare jargon. But underlying the jargon is the principle that a patient who receives such care strongly agrees that "I receive exactly the healthcare I want and need exactly when and how I want and need it." Currently only about 1 in 4 Americans who have adequate financial resources can make this claim. Think of a pyramid. At the apex is the highest level of "patient-centered, collaborative care." At the base are measures about "what's the matter" (from the clinical perspective) and "what matters" (from the patient perspective). As patients and clinicians act collaboratively on these measures, they climb closer to the apex of the pyramid. Given the realities of healthcare in the Unites States, should busy professionals take time to think about ways to climb pyramids? In this "Introduction" we describe why the answer to this rhetorical question ought to be "yes." In the articles that comprise this issue, readers will learn how technology that supports patient-centered, collaborative care can help bridge the gap between desirable goals and limited time. All the authors understand technology (such as hardware and software), and the way humans use the technology (called techne) will not overcome the many obstacles to the attainment of patient-centered, collaborative care. Nevertheless, we are hopeful that the examples described in these articles suggest ways that significant progress toward patient-centered, collaborative care can be made. The articles are practical. The results are persuasive. It is worth the climb!
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Abstract
This article addresses 2 questions. First, how useful is adult patients' information about health and healthcare when they use the Internet for a "health checkup"? We find that patietns' reports are very strongly associated with medical record information for blood pressure, cholesterol, and blood glucose. Second, what are the biases in information from Internet respondents? Although we find that "health checkup" Internet users seem to be representative for patients in actual practice, much more research will be needed to fully address this question.
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Abstract
In this report, we compare healthcare processes for patients with low (n = 7467) and adequate financial status (n = 43,701) after adjustment for age, gender, burden of illness, and health behaviors. Patients with low financial status were 10% to 30% less likely to report good service and collaborative care; they report that markers of disease management and prevention were 7% to 18% below the levels of patients with adequate income. From the patient perspective, these results confirm that inadequate financial status has a broad and adverse influence on health and healthcare. Technology for patient-centered, collaborative care alone will not remedy the problem of health disparity.
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Moore LG, Wasson JH, Johnson DJ, Zettek J. The Emergence of Ideal Micro Practices for Patient-centered, Collaborative Care. J Ambul Care Manage 2006; 29:215-21. [PMID: 16788354 DOI: 10.1097/00004479-200607000-00006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Ideal Micro Practices are capable of delivering patient-centered collaborative care. With respect to comparable adult patients in "usual" care settings, twice as many patients who use Ideal Micro Practices report they receive care that is "exactly what they want and need exactly when and how they want and need it" (68% vs 35%). Compared to usual care, these very small, low-overhead practices are more likely to have patients report very high levels of continuity (98% vs 88%), efficiency (95% vs 73%), and access (72% vs 53%). Patient ratings of very good information (83% vs 67%) and clinician awareness of pain or emotional problem are also higher (87% vs 69%). However, only a slim majority of patients using Ideal Micro Practices report that they are confident in their ability to manage and control their health problems or concerns. Ideal Micro Practices are sharing new tools and approaches to better understand their patients' needs and increase patients' confidence in their ability to manage conditions. In addition, these practices are working collaboratively to standardize their approaches and make the essential elements of Ideal Micro Practice replicable.
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Ahles TA, Wasson JH, Seville JL, Johnson DJ, Cole BF, Hanscom B, Stukel TA, McKinstry E. A controlled trial of methods for managing pain in primary care patients with or without co-occurring psychosocial problems. Ann Fam Med 2006; 4:341-50. [PMID: 16868238 PMCID: PMC1522168 DOI: 10.1370/afm.527] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2005] [Revised: 12/12/2005] [Accepted: 01/10/2006] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Pain, a common reason for visits to primary care physicians, is often not well managed. The objective of this study was to determine the effectiveness of pain management interventions suitable for primary care physicians. METHODS Patients from 14 rural primary care practices (47 physicians) who reported diverse pain problems with (n = 644) or without (n = 693) psychosocial problems were randomized to usual-care or intervention groups. All patients in the intervention group received information tailored to their problems and concerns (INFO). These patients' physicians received feedback about their patients' problems and concerns (FEED). A nurse-educator (NE) telephoned patients with pain and psychosocial problems to teach problem-solving strategies and basic pain management skills. Outcomes were assessed with the Medical Outcomes Study 36-Item Short-Form and the Functional Interference Estimate at baseline, 6 months, and 12 months. RESULTS Patients with pain and psychosocial problems randomized to INFOFEED+NE significantly improved on the bodily pain (P = .011), role physical (P = .025), vitality (P <.001), role emotional (P = .048), and the Functional Interference Estimate (P = .027) scales compared with usual-care patients at 6 months. These improvements were maintained at the 12-month assessment even though these patients had received, on average, only 3 telephone calls. Compared with usual-care patients, at 6 months patients who received INFOFEED alone experienced minimal improvements that were not sustained at the 12-month assessment. CONCLUSIONS For patients with pain and psychosocial problems, telephone-based assistance resulted in significant, sustained benefit in pain and psychosocial problems.
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Wasson JH, Ahles T, Johnson D, Kabcenell A, Lewis A, Godfrey MM. Resource Planning for Patient-centered, Collaborative Care. J Ambul Care Manage 2006; 29:207-14. [PMID: 16788353 DOI: 10.1097/00004479-200607000-00005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
In this article, we use self-reported information from 13,271 older adults and the results from several controlled trials to construct a planned-care management strategy that cuts across diseases and conditions and also addresses health disparities attributed to low socioeconomic status. Three strata result from the interaction of patients' financial status, the presence or absence of bothersome pain and psychosocial problems, and their confidence with self-care. A majority of ambulatory patients generally fall in the first stratum. More resources are required in the 2 remaining strata to attain patient-centered, collaborative care. Because the planned-care management strategy is behaviorally sophisticated, it is likely to be more efficient and effective than strategies based on concepts of disease management that focus on either a single disease or groupings of patients who are "high utilizers" of healthcare. We conclude that modern technologies and related approaches make resource planning for patient-centered, collaborative care feasible and desirable.
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