Frequency and prioritization of patient health risks from a structured health risk assessment.
OBJECTIVE
To describe the frequency and patient-reported readiness to change, desire to discuss, and perceived importance of 13 health risk factors in a diverse range of primary care practices.


METHODS
Patients (n = 1,707) in 9 primary care practices in the My Own Health Report (MOHR) trial reported general, behavioral, and psychosocial risk factors (body mass index [BMI], health status, diet, physical activity, sleep, drug use, stress, anxiety or worry, and depression). We classified responses as "at risk" or "healthy" for each factor, and patients indicated their readiness to change and/or desire to discuss identified risk factors with providers. Patients also selected 1 of the factors they were ready to change as most important. We then calculated frequencies within and across these factors and examined variation by patient characteristics and across practices.


RESULTS
On average, patients had 5.8 (SD = 2.12; range, 0-13) unhealthy behaviors and mental health risk factors. About 55% of patients had more than 6 risk factors. On average, patients wanted to change 1.2 and discuss 0.7 risks. The most common risks were inadequate fruit/vegetable consumption (84.5%) and overweight/obesity (79.6%). Patients were most ready to change BMI (33.3%) and depression (30.7%), and most wanted to discuss depression (41.9%) and anxiety or worry (35.2%). Overall, patients rated health status as most important.


CONCLUSIONS
Implementing routine comprehensive health risk assessments in primary care will likely identify a high number of behavioral and psychosocial health risks. By soliciting patient priorities, providers and patients can better manage counseling and behavior change.
Implementation Sciences Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland (S.M.P., R.E.G., S. H-R.); Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (S.M.P.); Colorado Health Outcomes Program, University of Colorado; Aurora, Colorado (R.E.G.); Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia (G.B., R.T.S.); Health Promotion & Community Health Sciences, Health Science Center, Texas A&M University, Round Rock, Texas (M.G.O.); Department of Health Policy & Management, Fielding School of Public Health, UCLA, Los Angeles, California (B.A.G.); Leidos Biomedical Research, Inc, Division of Cancer Control and Population Sciences of the National Cancer Institute, New York Physicians Against Cancer (NYPAC), Herbert Irving Comprehensive Cancer Center, New York, New York (S.N.S-G.); Department of Family and Community Medicine, Carilion Clinic, Roanoke, Virginia (S.B.J.); Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, Virginia (S.B.J.); Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia (A.H.K.). smphillips@northwestern.edu.
Siobhan M
SM
Phillips
Implementation Sciences Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland (S.M.P., R.E.G., S. H-R.); Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (S.M.P.); Colorado Health Outcomes Program, University of Colorado; Aurora, Colorado (R.E.G.); Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia (G.B., R.T.S.); Health Promotion & Community Health Sciences, Health Science Center, Texas A&M University, Round Rock, Texas (M.G.O.); Department of Health Policy & Management, Fielding School of Public Health, UCLA, Los Angeles, California (B.A.G.); Leidos Biomedical Research, Inc, Division of Cancer Control and Population Sciences of the National Cancer Institute, New York Physicians Against Cancer (NYPAC), Herbert Irving Comprehensive Cancer Center, New York, New York (S.N.S-G.); Department of Family and Community Medicine, Carilion Clinic, Roanoke, Virginia (S.B.J.); Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, Virginia (S.B.J.); Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia (A.H.K.).
Russell E
RE
Glasgow
Implementation Sciences Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland (S.M.P., R.E.G., S. H-R.); Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (S.M.P.); Colorado Health Outcomes Program, University of Colorado; Aurora, Colorado (R.E.G.); Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia (G.B., R.T.S.); Health Promotion & Community Health Sciences, Health Science Center, Texas A&M University, Round Rock, Texas (M.G.O.); Department of Health Policy & Management, Fielding School of Public Health, UCLA, Los Angeles, California (B.A.G.); Leidos Biomedical Research, Inc, Division of Cancer Control and Population Sciences of the National Cancer Institute, New York Physicians Against Cancer (NYPAC), Herbert Irving Comprehensive Cancer Center, New York, New York (S.N.S-G.); Department of Family and Community Medicine, Carilion Clinic, Roanoke, Virginia (S.B.J.); Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, Virginia (S.B.J.); Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia (A.H.K.).
Ghalib
G
Bello
Implementation Sciences Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland (S.M.P., R.E.G., S. H-R.); Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (S.M.P.); Colorado Health Outcomes Program, University of Colorado; Aurora, Colorado (R.E.G.); Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia (G.B., R.T.S.); Health Promotion & Community Health Sciences, Health Science Center, Texas A&M University, Round Rock, Texas (M.G.O.); Department of Health Policy & Management, Fielding School of Public Health, UCLA, Los Angeles, California (B.A.G.); Leidos Biomedical Research, Inc, Division of Cancer Control and Population Sciences of the National Cancer Institute, New York Physicians Against Cancer (NYPAC), Herbert Irving Comprehensive Cancer Center, New York, New York (S.N.S-G.); Department of Family and Community Medicine, Carilion Clinic, Roanoke, Virginia (S.B.J.); Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, Virginia (S.B.J.); Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia (A.H.K.).
Marcia G
MG
Ory
Implementation Sciences Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland (S.M.P., R.E.G., S. H-R.); Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (S.M.P.); Colorado Health Outcomes Program, University of Colorado; Aurora, Colorado (R.E.G.); Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia (G.B., R.T.S.); Health Promotion & Community Health Sciences, Health Science Center, Texas A&M University, Round Rock, Texas (M.G.O.); Department of Health Policy & Management, Fielding School of Public Health, UCLA, Los Angeles, California (B.A.G.); Leidos Biomedical Research, Inc, Division of Cancer Control and Population Sciences of the National Cancer Institute, New York Physicians Against Cancer (NYPAC), Herbert Irving Comprehensive Cancer Center, New York, New York (S.N.S-G.); Department of Family and Community Medicine, Carilion Clinic, Roanoke, Virginia (S.B.J.); Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, Virginia (S.B.J.); Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia (A.H.K.).
Beth A
BA
Glenn
Implementation Sciences Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland (S.M.P., R.E.G., S. H-R.); Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (S.M.P.); Colorado Health Outcomes Program, University of Colorado; Aurora, Colorado (R.E.G.); Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia (G.B., R.T.S.); Health Promotion & Community Health Sciences, Health Science Center, Texas A&M University, Round Rock, Texas (M.G.O.); Department of Health Policy & Management, Fielding School of Public Health, UCLA, Los Angeles, California (B.A.G.); Leidos Biomedical Research, Inc, Division of Cancer Control and Population Sciences of the National Cancer Institute, New York Physicians Against Cancer (NYPAC), Herbert Irving Comprehensive Cancer Center, New York, New York (S.N.S-G.); Department of Family and Community Medicine, Carilion Clinic, Roanoke, Virginia (S.B.J.); Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, Virginia (S.B.J.); Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia (A.H.K.).
Sherri N
SN
Sheinfeld-Gorin
Implementation Sciences Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland (S.M.P., R.E.G., S. H-R.); Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (S.M.P.); Colorado Health Outcomes Program, University of Colorado; Aurora, Colorado (R.E.G.); Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia (G.B., R.T.S.); Health Promotion & Community Health Sciences, Health Science Center, Texas A&M University, Round Rock, Texas (M.G.O.); Department of Health Policy & Management, Fielding School of Public Health, UCLA, Los Angeles, California (B.A.G.); Leidos Biomedical Research, Inc, Division of Cancer Control and Population Sciences of the National Cancer Institute, New York Physicians Against Cancer (NYPAC), Herbert Irving Comprehensive Cancer Center, New York, New York (S.N.S-G.); Department of Family and Community Medicine, Carilion Clinic, Roanoke, Virginia (S.B.J.); Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, Virginia (S.B.J.); Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia (A.H.K.).
Roy T
RT
Sabo
Implementation Sciences Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland (S.M.P., R.E.G., S. H-R.); Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (S.M.P.); Colorado Health Outcomes Program, University of Colorado; Aurora, Colorado (R.E.G.); Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia (G.B., R.T.S.); Health Promotion & Community Health Sciences, Health Science Center, Texas A&M University, Round Rock, Texas (M.G.O.); Department of Health Policy & Management, Fielding School of Public Health, UCLA, Los Angeles, California (B.A.G.); Leidos Biomedical Research, Inc, Division of Cancer Control and Population Sciences of the National Cancer Institute, New York Physicians Against Cancer (NYPAC), Herbert Irving Comprehensive Cancer Center, New York, New York (S.N.S-G.); Department of Family and Community Medicine, Carilion Clinic, Roanoke, Virginia (S.B.J.); Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, Virginia (S.B.J.); Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia (A.H.K.).
Suzanne
S
Heurtin-Roberts
Implementation Sciences Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland (S.M.P., R.E.G., S. H-R.); Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (S.M.P.); Colorado Health Outcomes Program, University of Colorado; Aurora, Colorado (R.E.G.); Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia (G.B., R.T.S.); Health Promotion & Community Health Sciences, Health Science Center, Texas A&M University, Round Rock, Texas (M.G.O.); Department of Health Policy & Management, Fielding School of Public Health, UCLA, Los Angeles, California (B.A.G.); Leidos Biomedical Research, Inc, Division of Cancer Control and Population Sciences of the National Cancer Institute, New York Physicians Against Cancer (NYPAC), Herbert Irving Comprehensive Cancer Center, New York, New York (S.N.S-G.); Department of Family and Community Medicine, Carilion Clinic, Roanoke, Virginia (S.B.J.); Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, Virginia (S.B.J.); Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia (A.H.K.).
Sallie Beth
SB
Johnson
Implementation Sciences Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland (S.M.P., R.E.G., S. H-R.); Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (S.M.P.); Colorado Health Outcomes Program, University of Colorado; Aurora, Colorado (R.E.G.); Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia (G.B., R.T.S.); Health Promotion & Community Health Sciences, Health Science Center, Texas A&M University, Round Rock, Texas (M.G.O.); Department of Health Policy & Management, Fielding School of Public Health, UCLA, Los Angeles, California (B.A.G.); Leidos Biomedical Research, Inc, Division of Cancer Control and Population Sciences of the National Cancer Institute, New York Physicians Against Cancer (NYPAC), Herbert Irving Comprehensive Cancer Center, New York, New York (S.N.S-G.); Department of Family and Community Medicine, Carilion Clinic, Roanoke, Virginia (S.B.J.); Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, Virginia (S.B.J.); Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia (A.H.K.).
Alex H
AH
Krist
D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology; D001007:Anxiety / Q000453:epidemiology; D015992:Body Mass Index; D003142:Communication; D003863:Depression / Q000453:epidemiology; D004032:Diet / Q000706:statistics & numerical data; D005260:Female; D015438:Health Behavior; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000379:methods* / Q000706:statistics & numerical data*; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012890:Sleep; D012907:Smoking / Q000453:epidemiology; D013315:Stress, Psychological / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000453:epidemiology
health risk appraisal; patient-centered care; primary care