A qualitative study of patients' and physicians' views about practice-based functional health assessment.
BACKGROUND
Interest has increased in using patient-based measures of health status in everyday clinical practice. Patient reports of functioning and well-being have been most commonly used in clinical-practice settings at the group-level for research rather than at the individual-patient level for clinical decision-making.


OBJECTIVE
Little is known about patients' and physicians' preferences for practice-based functional health assessment. Qualitative methods were used to discover patient and physician attitudes about the use of functional health assessment tools in everyday clinical practice.


METHODS
Six focus groups were conducted with 39 asthma patients who had been invited to participate in practice-based functional health assessment (FHA). Thirty in-depth, semistructured interviews were conducted with physicians in a single health maintenance organization to discover their attitudes about practice-based FHA.


METHODS
A large group-model health maintenance organization in Southeastern Wisconsin that consists of 200,000 members and 315 providers across 22 locations. Patients were selected from the Asthma Clinic and physicians were selected among all MD providers.


RESULTS
Patients identified numerous practical implementation problems with practice-based FHA, including the site of data collection, feedback on their responses, and who would have access to the data. Patients also identified several barriers and benefits of practice-based FHA. Before they would commit financial and human capital resources and time, clinicians wanted information about the effectiveness and value of practice-based FHA.


CONCLUSIONS
Several barriers to practice-based FHA were identified by patients and physicians. The evidence-based barrier identified by physicians needs to be overcome with additional intervention studies that push the envelope on several fronts including: (1) the type of tool; (2) the type of patient; (3) the type of setting; and (4) the recipients of the information. Interpretation guides and assessment linkage steps need to be developed and tested.
McHorney
Colleen A
CA
Department of Medicine, Indiana University School of Medicine, Regenstrief Institute for Health Care, Indiana University Center for Aging Research, and Roudebush Veterans Administration Medical Center, Indianapolis 46202, USA. cmchorney@regenstrief.org
Earl Bricker
Donald
D
D001249:Asthma / Q000523:psychology; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D017144:Focus Groups; D006279:Health Maintenance Organizations; D006801:Humans; D007407:Interviews as Topic; D010358:Patient Participation; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D036301:Qualitative Research; D020377:Self Efficacy; D018434:Sickness Impact Profile; D014922:Wisconsin