Healthcare Analytics, Population Health Management, Healthcare Big Data

Population Health News

Can a 4-Question Survey Improve Chronic Disease Management?

Why is this four-question Healthy Days patient assessment different from all other chronic disease management assessments?

By Jennifer Bresnick

- A simple patient survey with no more than four questions may be all it takes to help providers get a handle on basic chronic disease management, according to a new study backed by a cross-industry collaboration.

Chronic disease management and population health management

The Healthy Days survey, developed and validated by the CDC, asks patients about their recent experiences, and includes questions about how often in the past thirty days they have felt physically or mentally unwell.

According to a review of academic literature published in the journal Population Health Management this week, the questions have the potential to evaluate a patient’s chronic conditions in a manner not usually captured by other population health management strategies.

“Traditional health measurements rely on data about morbidity and mortality and cost,” said Matthew Zack, MD, MPH, an epidemiologist with the Centers for Disease Control and Prevention, and one of the authors of the study. “But those metrics don’t always capture how individuals feel about their own health and well-being. The Healthy Days instrument captures that.”

The health-related quality of life (HRQOL) metric, which includes assessments of a patient’s physical, mental, emotional, and social functioning, is one of the core used by the Healthy People 2020 project to understand health at a community level, says the study.

READ MORE: CMS Urges Providers to Tackle Minority Health Disparities

“HRQOL can be used to measure health disparities, track the influence of social determinants on overall health, and shed light on the ultimate impact of the health care system,” write the authors, who hail from the CDC, Robert Wood Johnson Foundation, Columbia University, and Humana, Inc.

But finding the right methodology to assess HRQOL can be a challenge, the study added.  Providers are seeking population health and chronic disease management assessment tools that are quick and easy to implement and do not require undue effort from patients or clinicians to manage.

“The ideal instrument for those who manage population health would be holistic and easy to administer, and would measure the individual’s perspective while being understandable to health care providers and the general public alike,” says the review.

The Healthy Days survey meets all of those requirements.  In development since the 1980s, the short questionnaire asks the following:

Would you say that in general your health is excellent, very good, good, fair or poor?

READ MORE: NCQA: Patient-Centered Medical Home No Longer “Unduly Onerous”

Now thinking about your physical health, which includes physical illness and industry, for how many days during the past 30 days was your physical health not good?

Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?

During the past 30 days, for about how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, work, or recreation?

The CDC posits that asking about the number of days a patient is incapacitated due to illness, instead of looking through the lens of healthcare service utilization or spending, may be a better measure of the overall social and economic burden of chronic disease on a community, a family, and an individual.

The questions also provide a personalized entry point into more detailed conversations about chronic disease management, supported by a complementary set of ten additional questions.

READ MORE: Big Data Analytics Link Economic Wellness to Population Health

The expanded questions delve into the major causes and effects of any reported activity limitations, and also ask specifically about unhealthy days due to pain, depression, anxiety, or sleeplessness.

The CDC adds that field tests have shown that it is easier for patients to estimate the number of unhealthy days than the number of healthy ones, because most respondents typically have fewer periods of distress which may stand out more prominently in their minds.

CMS has used the tool as part of its data collection efforts for more than a decade, the study authors note.  The assessment is included in the Medicare Health Outcomes Survey, which helps to measure quality of care provided by Medicare Advantage programs.

Humana, which participated in the literature review, is also using the survey to help meet its own 2020 goal to improve community health by 20 percent by the end of the decade.

“Healthy Days could and should be used more broadly,” said co-author Laura Happe, PharmD, MPH, a strategic consultant at Humana. “We believe it could help federal, state, and local governments better understand the needs of their communities and help them identify vulnerable subpopulations.”

In addition to informing regulators and lawmakers about areas of concern, the tool may also play a role in helping healthcare organizations navigate the complex transition to value-based reimbursement models, which rely heavily on effective population health management techniques. 

Patient perceptions of their own health are a “critical element of defining value,” the study argues, and the use of accurate, validated strategies to measure quality of life will become an increasingly integral piece of the accountable care ecosystem.

“Patient-reported assessments of their health such as Healthy Days should play an important role in determining where value is being delivered and should be reflected in reimbursement models,” the authors write. “Accurate, reliable, and consistent measurement of quality of life using a validated measure like Healthy Days will help to identify promising payment solutions going forward.”

As healthcare organizations attempt to develop the chronic disease management capabilities that will support them as they move into value-based reimbursement, the availability of easy-to-use, simple-to-interpret, broadly accepted metrics to gauge patient perceptions of chronic disease management may become the foundation for future population health projects, the study concludes.

“Such a holistic view can more accurately isolate the most pressing health care needs of a population, measure improvements resulting from interventions that may otherwise take years to realize the outcomes benefits, and allocate the provision of health care services toward those that improve not only outcomes, but also quality of life.”


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