Article Figures & Data
Figures
- Figure 1.
Integrated Wellness Tool (IWT) provider electronic medical record interface. This interface may be viewed in the electronic medical record by providers after patients have completed the IWT. Risk scores are displayed for each wellness area, allowing providers to focus on those areas with the highest risk during the patient encounter. Providers may review and adjust patients' individual answers to the questionnaires and mark each area as “reviewed” using this interface. All patients automatically receive informational handouts tailored to their risk score in each wellness area. BMI, body mass index; COPD, Chronic Obstructive Pulmonary Disease.
- Figure 2.
Patient risk by wellness category, captured using the Integrated Wellness Tool (IWT). Risk scores are determined by patient responses to IWT questionnaires during the pilot (June 25 to September 4, 2013). Total responses for the various questionnaires were 702 for chronic obstructive pulmonary disease (COPD), 839 for nutrition, 805 for stress, 825 for exercise, 789 for depression, 734 for insomnia, and 621 for sleep apnea.
Tables
- Table 1.
Characteristics of Patients Who Participated in the Integrated Wellness Tool (IWT) Pilot and Matched Comparison Encounters
Comparison Group IWT Pilot Pre* (n = 863) Post† (n = 863) P Value Pre* (n = 863) Post† (n = 863) P Value Age, years (mean ± SD) 60.7 ± 15.5 60.7 ± 16.6 .95 57.7 ± 16.8 60.7 ± 14.9 <.01 Sex .96 .10 Female 566 (65.6) 565 (65.5) 551 (65.9) 583 (67.6) Male 297 (34.4) 298 (34.5) 312 (36.2) 280 (32.4) Race .42 .39 Black 59 (6.8) 61 (7.1) 71 (8.2) 60 (7.0) White 762 (88.3) 771 (89.3) 756 (87.6) 774 (89.7) Other 42 (4.9) 31 (3.6) 36 (4.2) 29 (3.4) Ethnicity .80 .59 Hispanic 8 (0.9) 10 (1.2) 2 (0.2) 1 (0.1) Not Hispanic 836 (96.9) 831 (96.3) 836 (96.9) 842 (97.6) Other/unknown 19 (2.2) 22 (2.6) 25 (2.9) 20 (2.3) BMI, kg/m2 (mean ± SD) 29.8 ± 7.0 29.0 ± 7.0 .02 28.5 ± 6.2 28.9 ± 6.3 .19 Smoking status .88 .37 Current 71 (8.2) 70 (8.1) 61 (7.1) 70 (8.1) Former 302 (35.0) 312 (36.2) 326 (37.8) 306 (35.5) Never 490 (56.8) 481 (55.7) 474 (54.9) 487 (56.4) Never assessed 0 (0) 0 (0) 2 (0.2) 0 (0) Comorbidities Type 2 diabetes 197 (22.8) 201 (23.3) .82 156 (18.1) 183 (21.2) .10 Hypertension 523 (60.6) 521 (60.4) .92 486 (56.3) 530 (61.4) .03 COPD 62 (7.2) 66 (7.7) .71 56 (6.5) 72 (8.3) .14 Sleep apnea 206 (23.9) 203 (23.5) .87 122 (14.1) 176 (20.4) <.01 Insomnia 28 (3.2) 22 (2.6) .39 19 (2.2) 23 (2.7) .53 Anxiety 212 (24.6) 201 (23.3) .53 199 (23.1) 200 (23.2) .95 Depression 214 (24.8) 226 (26.2) .51 213 (24.7) 236 (27.4) .21 Cardiovascular disease 273 (31.6) 269 (31.2) .84 239 (27.7) 277 (32.1) .05 Data are n (%) unless otherwise indicated.
↵* Patients from encounters matched to Integrated Wellness Tool (IWT) pilot encounters from the same practice (IWT pilot) and comparison practices (comparison group) that took place between February 11 and April 24, 2013.
↵† Patients from IWT pilot encounters (IWT pilot) and matched comparison encounters (comparison group) that took place between June 25 and September 4, 2013.
COPD, chronic obstructive pulmonary disease; SD, standard deviation; BMI, body mass index.
- Table 2.
Frequency of Order Placement by Primary Care Providers During the Integrated Wellness Tool Pilot and from Matched Comparison Groups
Order Comparison Group IWT Pilot Pre* Post† P Value Pre* Post† P Value Breathing (COPD) Spirometry 3 (0.4) 3 (0.4) .66 15 (1.7) 51 (5.9) <.01 Consult to smoking cessation 1 (0.1) 2 (0.2) .50 4 (0.5) 21 (2.4) <.01 Smoking cessation drug order 4 (0.5) 8 (0.9) .19 11 (1.3) 10 (1.2) .91 Albuterol order 18 (0.2) 9 (1.0) .08 15 (1.7) 14 (1.6) .97 Nutrition Consult to Go! Foods For You 2 (0.2) 1 (0.1) .88 12 (1.4) 21 (2.4) .04 Consult to nutrition therapy 7 (0.8) 4 (0.5) .89 17 (2.0) 23 (2.7) .30 Stress Consult to Stress Free Now! 0 (0) 1 (0.1) .50 8 (0.9) 47 (5.5) <.01 Consult to integrative medicine 0 (0) 1 (0.1) .50 0 (0) 2 (0.2) 1.00 Exercise Consult to lifestyle medicine 0 (0) 0 (0) — 0 (0) 21 (2.4) <.01 Depression Consult to psychology 7 (0.8) 12 (1.4) .25 9 (1.0) 20 (2.3) .04 Consult to psychiatry 4 (0.5) 9 (1.0) .13 6 (0.7) 14 (1.6) .07 Antidepressant drug order 38 (1.5) 46 (5.3) .37 34 (3.9) 62 (7.2) .01 Insomnia Consult to Go! To Sleep 0 (0) 0 (0) — 6 (0.7) 18 (2.1) .01 Consult to behavioral sleep medicine Group 0 (0) 0 (0) — 0 (0) 1 (0.1) 1.00 Individual 0 (0) 0 (0) — 0 (0) 2 (0.2) 1.00 Insomnia drug order 8 (1.5) 13 (4.4) .27 6 (0.7) 19 (2.2) .01 Sleep apnea Polysomnogram 11 (1.3) 13 (1.5) .68 11 (1.3) 54 (6.3) <.01 Consult to sleep medicine 2 (0.2) 5 (0.6) .23 6 (0.7) 8 (0.9) .76 Data are no. of encounters with order (percentage of 863 total encounters per group), unless otherwise indicated. All comparisons were adjusted for age and sleep apnea, hypertension, and cardiovascular disease status.
COPD, chronic obstructive pulmonary disease; IWT, Integrated Wellness Tool.
↵* Number of patients whose risk score prompted the order using the Integrated Wellness Tool.
↵† Percentage values are the proportions of the totals.
- Table 3.
Order Placement and Follow-Through for Patients with Elevated Integrated Wellness Tool Risk Scores, By Wellness Area
Test Completed Questionnaires, n At Risk,* n (%) Order Placed, n (%)† Completed n (%)† Smoking 863 70 (8) Smoking cessation 21 (30) Prescription 5 (7) COPD 702 98 (14) Albuterol 4 (4) Spirometry 31 (32) 18 (58) Nutrition 839 749 (89) Go! Foods For You 22 (3) Nutrition therapy 22 (3) 6 (27) Stress 805 428 (53) Stress Free Now 40 (9) Integrative medicine 2 (0.5) 0 (0) Exercise 825 280 (34) Lifestyle medicine 14 (5) 1 (7) Depression 789 175 (22) Psychology 17 (10) 2 (12) Psychiatry 11 (6) 1 (9) Prescription 29 (17) Insomnia 734 79 (11) Behavioral sleep medicine (group) 1 (1) 0 (0) Behavioral sleep medicine (individual) 2 (3) 0 (0) Go! To Sleep 8 (6) Prescription 4 (6) Sleep apnea 621 166 (27) Sleep medicine 3 (2) 0 (0) Polysomnography 42 (25) 13 (31) Nutrition Questionnaire
Do you read ingredient labels to avoid added sugars and syrups before deciding on an item? All the time 0 Most of the time 1 Some of the time 4 Never 7 How many servings (1 serving is approximately 1 handful) of fruits and vegetables do you eat a day, on average? Do not count juice or dried fruits. 0–1 7 2–3 3 ≥4 0 Do you avoid saturated fat? (Saturated fat is found in all 4-legged animal products [eg, cows/pigs], 2-legged animal skin [eg, chickens], and packaged or baked foods with butter, margarine, lard, palm, coconut, or cottonseed oils.) All of the time 0 Most of the time 2 Some of the time 5 Never 7 How many servings (1 serving is approximately 1 handful) of processed meat do you eat in a typical week (items include bacon, sausage, ham, hot dogs, deli meats, and others)? 1–2 1 3–4 4 ≥5 8 When eating grains such as rice, bread, cereal, and pasta, what percentage of them are 100% whole grain? None 7 Some 5 Most 3 All 0 How many days a week do you eat breakfast? 0–1 7 2 6 3 5 4 4 5 3 6 2 7 1 How many days a week do you eat fried foods or foods with partially hydrogenated oils (think margarine, cookies, cake, crackers)? 0–1 0 2–3 4 4–6 6 BMI (kg/m2)* 19–27 A <19 B >27-31 C >31-35 D >35 E Scoring for eating habits Good Score: 0–10 and BMI in category A Smartset recommendations: consult to GO! Foods for You, Good Eating Habits educational handout Fair Score: 11–20 and BMI in category A or <20 and BMI in category B or C Smartset recommendations: consult to nutrition therapy, consult to GO! Foods for You, Fair Eating Habits educational handout Poor Score: >20 and BMI in any category or >1 and BMI in category D or E Smartset recommendations: consult to nutrition therapy, consult to GO! Foods for You, Poor Eating Habits educational handout ↵* Body mass index (BMI) data from the electronic medical record.
Placement of Orders Recommended by the Integrated Wellness Tool, by Reviewed Status
Reviewed Not Reviewed P Value Smoking Consult to smoking cessation 19 (43) 2 (8) .01 Smoking cessation prescription 3 (7) 2 (8) .74 COPD Spirometry 29 (41) 2 (7) <.01 Albuterol prescription 4 (6) 0 (0) .25 Nutrition Consult to Go! Foods For You 22 (4) 0 (0) <.01 Consult to nutrition therapy 18 (4) 4 (2) .15 Stress Consult to Stress Free Now 47 (8) 0 (0) <.01 Consult to integrative medicine 2 (1) 0 (0) .46 Exercise Consult to lifestyle medicine 13 (7) 1 (1) .03 Depression Consult to psychology 17 (15) 0 (0) <.01 Consult to psychiatry 10 (9) 1 (2) .07 Antidepressant prescription* 19 (16) 10 (17) .92 Insomnia Consult to Go! To Sleep 16 (8) 0 (0) .03 Consult to behavioral sleep medicine Group 1 (2) 0 (0) .68 Individual 2 (4) 0 (0) .46 Insomnia prescription* 4 (7) 0 (0) .21 Sleep apnea Polysomnography 41 (36) 1 (2) <.01 Consult to sleep medicine 3 (3) 0 (0) .33 Data are n (%) unless otherwise indicated. Percentage values are the proportions of orders placed among those recommended by the Integrated Wellness Tool (IWT) that had been marked as reviewed/not reviewed by the provider using the IWT electronic medical record interface.
↵* Not included in Integrated Wellness Tool order recommendations.
COPD, chronic obstructive pulmonary disease.
