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Vital Signs

Website asks patients: "How's your health?"

By Roger P. Smith, Ph.D.

Thousands of patients in Chicago, Ill.; Long Beach, Calif.; and other cities across the country may not know it, but they're being cared for, in part, by a member of the Dartmouth faculty. Those are among the cities where large numbers of doctors have asked their patients to go online and, before their next appointment, fill out a survey at www.howsyourhealth.org.

The site was the brainchild of DMS's Dr. John Wasson, a nationally recognized leader in health-care quality improvement; several of his colleagues in DMS's Department of Community and Family Medicine; and Dr. Regina Benjamin, founder of a rural clinic in Alabama.

Specific: The survey is deceptively simple. After answering a number of basic questions, the patient gets back a summary of findings plus a list of sources of further information about his or her own specific health situation. An individual of average intelligence and health may at about that point be thinking, "So what? This isn't telling me anything I didn't already know—after all, who supplied the information in the first place?"

The site is deceptively simple. There is more to it
than meets the eye.

But there is much more to the site than meets the eye. It is only a small part of a system that has been 10 years in the making and is now improving the quality of care delivered all over the U.S. First, the website is a place where patients can collect and easily retrieve their own health information and concerns; 100,000 patients have now filled out the survey. Second, it provides patients with tools to inspire confidence in themselves so that, as Wasson puts it, they "can and should take control of [their] own health and health care."

Anyone can use the site—not just those whose doctors have adopted it as a tool. For example, this writer filled out the survey and was told that at my next appointment I should ask my doctor, "What medications am I taking, in what doses, what are they for, and how much do they cost?" I was reminded to include nonprescription drugs, herbal medications, and nutritional supplements. And I was told to ask, "What vaccinations

Even on a clear day, it's not possible to see the Chicago skyline from Dartmouth. But the Dartmouth experts behind an innovative website can see aggregate health information on 100,000 patients—in Chicago and other cities across the country.

do I need to keep track of? And where can I get reliable information in a form I can understand so I can talk about my health in an informed way?" And that, the site's creators feel, can't help but improve outcomes.

Wasson and his teamhave recruited cities and organizations from all across the U.S. to sign on to use the site—at no charge. For example, in Chicago and Long Beach, they worked with the Chambers of Commerce. In Chicago, Mayor Richard Daley taped TV spots asking, "How's your health, Chicago?" A sizeable segment of the population then went on the website and filled out the survey.

Innovative: Then comes an even more innovative and useful part of the system.When enough people in a city have filled out the survey, the aggregate information—stripped of personal identifiers—goes in to a database that allows publichealth officials tomake informed decisions about the quality and delivery of care. The state of New Jersey and the city of Milwaukee, Wisc., have been particularly enthusiastic about this capability.

In addition, once enough of a given doctor's patients have filled out the survey, that doctor can use the database to ask questions like "What percentage of my patients are seeing another doctor?" It's not common for patients to volunteer such information or for doctors to ask—

but it can be very important to a patient's health for that information to be known. Or a doctor might ask, "How many of my patients have feelings of depression that they haven't told me about?" Many patients will conceal such feelings unless prodded about them.

The benefits run deeper still. All the information from patients all over the country goes into a very sophisticated database that promises to yield valuable information about the health of the nation as a whole.

For example, participating doctors can compare their practice patterns with those of other doctors, asking such questions as "How does my handling of allergies compare with that of other doctors?" or "Am I using the best possible medicines to treat a given condition—with appropriate consideration for efficacy, safety, and cost?"

Aggregated: And at the most aggregated level, the database will allow national outcomes researchers to track regional differences and other variables in patterns of care and pinpoint what does and what does not make for differences in the quality of care.

For that, of course, is what everyone is after—from the patient in Long Beach, Calif., to the doctor in Lebanon, N.H.

If you'd like to offer feedback about this article, we'd welcome getting your comments at DartMed@Dartmouth.edu.

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