Goal Setting for Health Behavior and Psychosocial Issues in Primary Care
Condition: Health Behaviors; Obesity; Substance Abuse; Anxiety; Depression
MeSH terms: Substance-Related Disorders
Study type: Interventional

Summary: 
      The purpose of this delayed cluster randomized intervention trial is to evaluate primary care
      strategies to increase goal setting, shared decision-making and evidence-based support and
      counseling for health behaviors and psychosocial issues through the implementation of a
      standard set of practical, patient-centered survey items and related decision support tools,
      called the My Own Health Report (MOHR) assessment. Nine pairs of diverse primary care
      practices will participate, four pairs of federally qualified health centers clinics and 5
      pairs of practice based research network practices. Practice pairs are similar in size,
      patient and staff mix, culture, and level of EHR integration. Within pairs, practices will be
      randomized to early or delayed intervention (4 months later). The intervention consists of
      implementing the MOHR assessment and patient counseling into clinical care for all patients
      presenting for wellness or chronic care during a 6 month study period. Prior to
      implementation, practices will receive brief training about health behavior counseling, goal
      setting, and action planning. Practices will also be provided materials to support
      evidence-based counseling and referrals to local community resources. MOHR assessment
      implementation details will be determined by each practice pair but will generally include
      (1) asking patients to complete the MOHR assessment on the web prior to encounters (available
      at www.MyOwnHealthReport.org it addresses10 distinct health behaviors and psychosocial issues
      including physical activity, diet, alcohol consumption, tobacco use, drug use, sleep, stress,
      depression and anxiety), (2) provision, via the tool, immediate patient feedback that
      includes identification of unhealthy issues, assessment of readiness to change,
      prioritization of issues to change, and preparation for goal-setting and action planning, (3)
      feedback to the primary care team on the patient status and priorities for change, (4)
      provision of counseling, goal setting, and referrals to local resources by clinicians during
      the subsequent office visit, and (5) follow-up with the clinicians and local resources as
      agreed upon by the patient and clinician. Data sources will include patient responses to the
      MOHR assessment, practice appointment records, and a patient experience survey mailed to the
      first 300 patients offered the MOHR assessment two weeks after their office visit. Primary
      outcomes will include the Reach and Effectiveness of the intervention. Reach will be assessed
      in early and delayed intervention sites when they field the MOHR assessment. Effectiveness
      will compare early and delayed intervention sites during the early intervention phase,
      allowing the delayed intervention sites to serve as controls. Reach outcomes will include the
      percent of eligible patients receiving and completing the MOHR assessment. Effectiveness
      outcomes will include the percent of patients reporting that they were asked about health
      topics, set a change goal, received assistance for making a change, were referred for local
      counseling and support, and/or made any changes. Additional outcomes will include maintenance
      of the MOHR assessment implementation beyond 4 months, changes in patient reported health
      behavior and psychosocial measures by repeated administration of the MOHR assessment 4 months
      after initial completion, qualitative assessments on implementation factors and context that
      influence outcomes, and cost, in terms of time and resources required for practices to
      implement the MOHR assessment.
    


Intervention name(s): Implementation of the MOHR assessment in primary care workflow
Intervention type(s): Other
Intervention description(s): The MOHR assessment includes (1) asking patients to complete the MOHR assessment on the web prior to encounters (available at www.MyOwnHealthReport.org it addresses10 distinct health behaviors and psychosocial issues including physical activity, diet, alcohol consumption, tobacco use, drug use, sleep, stress, depression and anxiety), (2) provision, via the tool, immediate patient feedback that includes identification of unhealthy issues, assessment of readiness to change, prioritization of issues to change, and preparation for goal-setting and action planning, (3) feedback to the primary care team on the patient status and priorities for change, (4) provision of counseling, goal setting, and referrals to local resources by clinicians during the subsequent office visit, and (5) follow-up with the clinicians and local resources as agreed upon by the patient and clinician.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention