Benefits and obstacles of health status assessment in ambulatory settings. The clinician's point of view. The Dartmouth Primary Care COOP Project.
In the past decade physicians have identified the need to expand patient assessment to include global function and quality of life. During the same period, the busy clinic has evolved into the location where this assessment seems most appropriate. Integrating functional health assessment into a busy clinical practice is difficult because the necessary steps require time, thought, recording, and follow-up. Attention to the office ecosystem is very important before any patient care management method is introduced. The clinician must transform the results of health status screening into a specific functional diagnosis. The clinician has to understand the sensitivity, specificity, and predictive value of the measure for a preliminary diagnosis to be made. Often, additional measurements must be taken to establish a specific diagnosis. These steps encompass assessment linkage. Once the specific cause for the dysfunction is recognized, the clinician then has to determine the need for special resources. This is called the resource linkage. By following the steps outlined in this paper, the clinician should be able to overcome many obstacles for functional health status assessment in busy ambulatory settings.
Wasson
J
J
Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Hanover, NH.
Keller
A
A
Rubenstein
L
L
Hays
R
R
Nelson
E
E
Johnson
D
D
D000203:Activities of Daily Living / Q000145:classification; D000553:Ambulatory Care / Q000379:methods* / Q000592:standards; D001291:Attitude of Health Personnel; D015984:Causality; D002908:Chronic Disease; D002985:Clinical Protocols / Q000592:standards; D003663:Decision Trees; D005568:Forms and Records Control; D006295:Health Resources; D006297:Health Services Accessibility / Q000592:standards; D006305:Health Status Indicators; D006801:Humans; D008487:Medical History Taking; D008499:Medical Records / Q000592:standards; D010819:Physician's Role; D010820:Physicians / Q000523:psychology; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011788:Quality of Life; D012017:Referral and Consultation / Q000592:standards; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014481:United States