February 26, 1997 Julie Rennecker

Terminology

Health Assessment--a survey exam of a presumably well person--history, exam, screening tests for purpose of evaluating health status, identifying risks, and detecting early symptoms of illness.

Health Assessment System--a systematic approach to providing health assessments to an entire patient population tailored to address the health-care needs of target groups (i.e., elderly, young women of child-bearing age, high-risk occupations groups, etc.)

Multi-phasic testing program--a health assessment system; a series of stations visited by the clients; usually staffed with nursing and paramedical personnel (pg. 563 for list of common stations)

Automated Multiphasic Health Testing System (AMHT)--a health assessment process using automated instruments to analyze specimens and generate reports

Automated Multiphasic Health-testing Services--an AMHT that incorporates a health assessment information system that provides decision support as well as clerical operations (scheduling, patient recall, registration, etc.) and that provides additional services such as patient triaging, health counseling, patient education, and preventive health maintenance.

Purposes of Health Assessment Systems

- Prehospital workups

- Baseline health assessments to new enrollees to a healthcare plan

- Occupational health assessments and risk evaluations (usually done on-site)

- Physicals to satisfy administrative requirements--pre-employment; school entrance physical, etc.

Goals of Health Assessment Systems

- Decrease morbidity, disability, and mortality in a population through early detection & prevention

- Reduce total medical costs through more efficient use of health-care resources--disease is usually cheaper to treat if caught early; screenings can be performed less expensively if done en masse and by non-physician personnel

Designing a Health Assessment System

Test/Station Selection

* Tests should screen for illnesses prevalent in the population (e.g., glaucoma is rare in children)

* Tests should be for illnesses that are potentially disabling, life-threatening, or that threaten the quality of life.

* Appropriate follow-up should be available for the condition ("I'm sorry Mr. Jones, we've discovered that you have XYZ and there are no resources available in our nation for your condition.")

System Components

1. Patient Registration & Identification

2. Operational Support--scheduling, labels for specimens, storage and retrieval of clinical record

3. Data Collection--manual input by healthcare workers, interface with automated instruments, client interface

4. Report generation and data retrieval--should support ad hoc as well as routine reporting

5. Data processing using decision rules

History and Status of Health-Assessment Systems

- Health screening as a public health measure began before 1900's--screening of immigrants by Marine Hospital Service

- 1948-- introduction of multi-phasic screening to decrease costs of screening large numbers of people

- 1951-- Kaiser-Permanente implemented the first MHTP to be included in a comprehensive prepaid health plan

- 1963-- First automated MHTP replaced Kaiser's original system--35,000 clients screened

- 1970's--proliferation of programs throughout developed countries--US (300), Japan (40), Europe (30)

- Since 1970's, proliferation has continued in Japan & Europe while use and numbers have declined in the United States

- Many US clients already receive the tests provided by the HAS when they visit their MD for other purposes

- No financial incentives for Mds to refer clients to these services (in traditional reimbursement situ)

- Insurance companies (including Medicare & Medicaid) don't reimburse

- 1964-1975--Longitudinal study by Kaiser (controlled trial) revealed that while some benefits were realized, the overall medical costs were greater for those receiving annual screenings

- Mortality from "potentially preventable" illnesses was significantly less in study group

- No difference in overall mortality rate for study and control groups

- Analysis done on expenditures for a more limited segment of the test population indicated no net savings.

- Primary benefit seems to be less lost work time due to illness--a benefit for employers which accounts for why company-sponsored programs are one of the primary areas of application