Details About the HowsYourHealth Tool

The HowsYourHealth family of tools are distributed for free to benefit people of all ages and circumstances. These tools are completely private…only you decide what to do with your information.

We use Research to make sure the questions and information really helps you take better care of yourself and helps you get better health care. For more than thirty years, a cooperative network of physicians, nurses, and researchers affiliated with Dartmouth Medical School has developed approaches to make care truly responsive to the needs of the population. John Wasson MD, emeritus professor at Dartmouth Medical School has overseen this work. *HowsYourHealth.org* is derived from this experience and has been shown to be effective and useful in several published research studies.(see below) Generous support for this work has been provided by The John A. Hartford Foundation, The Robert Wood Johnson Foundation, The Henry J. Kaiser Foundation, The W.T. Grant Foundation, The Agency for Health Care Research and Quality, and the Commonwealth Fund. These funding sources have had absolutely no influence on the editorial content of the web site.

In 1992, the underlying approach for HowsYourHealth.org was officially adopted for international use in more than 20 languages by the World Organization of Primary Care.

Publications and Comments


While HowsYourHealth.org and HealthConfidence.org are serving different users we perform research and development activities to continuously improve service and share our results (often through publications) with others.

A summary about the research and development of HowsYourHealth is available (https://link.springer.com/article/10.1007/s11136-020-02528-z).

This report demonstrates the value of HowsYourHealth for the betterment of both patient and population health. The following Table categorizes the research and development. NOT INCLUDED IN THE TABLE ARE THE INNUMERABLE TESTS PERFORMED BY PRACTICE, COMMUNITY OR EMPLOYER SPONSORS OF HOWSYOURHEALTH WHO CUSTOMIZE THE ASSESSMENTS TO INCLUDE QUESTIONS OF INTEREST TO THEM.

Validation of Measures and Queries to Serve Respondents – What Matters
Topic Reference(s) Comment
The What Matters Index
Wasson JH. A "What Matters Index" (WMI) for Adolescents.
J Ambul Care Manage. 2023 Apr-Jun 01;46(2):121-126. doi: 10.1097/JAC.0000000000000456. Epub 2023 Jan 23. PMID: 36662156; PMCID: PMC9946159.
Wasson JH, Ho L, Soloway L, Moore LG (2018)
Validation of the What Matters Index: A brief, patient-reported index that guides care for chronic conditions and can substitute for computer-generated risk models. PLoS ONE 13(2): e0192475. https://doi.org/10.1371/journal.pone.0192475
Wasson JH , Soloway L, Moore LG, Labrec P, and Ho L.
Development of a Care Guidance Index Based On What Matters to Patients . Qual Life Res. https://www.ncbi.nlm.nih.gov/pubmed/28401418 (2017) Apr 11. doi: 10.1007/s11136- 017-1573-x.
Highly relevant for the evaluation and management of both patient and population health.
Patient Reported Data for Quality and Outcome
Wasson JH. A Brief Review of Single-Item and Multi-item Quality of Life Measures for
Medicare Patients. Journal of Ambulatory Care Management 2019 42 21-26 https://journals.lww.com/ambulatorycaremanagement/Fulltext/2019/01000/A_Brief_Review_of_Single_Item_and_Multi_Item.3.aspx
Nelson EC, Eftimovska E, Lind C, et.al. Patient reported outcome
measures in practice. 2015. BMJ;350:g7818 doi: 10.1136/bmj.g7818 (Published 10 February 2015) http://www.bmj.com/content/350/bmj.g7818
An international review of HowsYourHealth and a comparison of the What Matters Index to more complicated, but popular measures.
General Function
Nelson EC, Landgraf JM, Hays RD, Wasson JH, Kirk JW. The functional
status of patients: How can it be measured in physicians' offices? Med Care 1990;28 (12):1111-1126.
Nelson EC, Wasson JH, Johnson DJ, Hays RD. Dartmouth COOP Functional
Health Assessment Charts: Brief Measures for Clinical Practice. In: Spilker B, ed. Quality of Life and Pharmacoeconomics in Clinical Trials. Philadelphia: Lippincott-Raven. 1996:161-168.
Bronfort G, and Bouter LM. Responsiveness of general health status in
chronic low back pain: a comparison of the COOP Charts and the SF-36. 1999 Pain 83; 201-209
Single item COOP/WONCA “charts” are well-suited to everyday use and adopted worldwide; they compare well to longer measures
Adolescent Function
Wasson JH, Kairys SW, Nelson EC, Kalishman N, Baribeau P. A short
survey for assessing health and social problems of adolescents. J Fam Prac 1994; 38(5):489-494.
Wasson JH, Kairys SW, Nelson EC, et al. Adolescent health and social
problems. Arch Fam Med 1995;4:51-56.
What matters to teens and ways to respond to their needs
Dialysis Patients
Rettig RA, Sadler JH, Meyer KB, Wasson JH, et al. Assessing health and
quality of life outcomes in dialysis: A Report on an Institute of Medicine Workshop. Amer J Kidney Dis 1997; 30(1): 140-155.
General functional assessment is adequate for dialysis
Important Issues for the Elderly Wasson JH, Stukel TA, Weiss JE, Hays RD, Jette AM, Nelson EC. A Randomized Trial Of Using Patient Self-Assessment Data To Improve Community Practices. Effective Clinical Practice 1999; 2:1-10 Assessment of intervention on broad range of needs
Doctor and Patient Interaction Magari ES, Hamel MB, Wasson JH. An Easy Way to Measure Quality of Physician-Patient Interactions. J.AMB.CARE.MGMT. 1998; 21(3): 27-33. Patients report clinicians’ awareness of functional needs
Abusive relationships of women Wasson JH, Jette AM, Anderson J, Johnson DJ, Nelson EC, Kilo CM. Routine, single-item screening to identify abusive relationships in women. J Fam Practice 2000; 49(11): 1017-1024. A very useful screener for a veiled problem
Adverse Events
Wasson JH, Mackenzie TA, Hall M. Patients Use an Internet Technology
to Report When Things Go Wrong. 2007 Quality and Safety in Health Care; 2007:16:213-217.
Wasson JH. A Patient-Reported Spectrum of Adverse Health Care
Experiences: Harms, Unnecessary Care, Medication Illness, and Low Health Confidence. 2013. J Ambulatory Care Manage: Vol. 36, No. 3, pp. 245–250
Patient report of adverse events is valid and easy to obtain
Overall Care Quality
Wasson JH, Baker NJ. Balanced Measures for Patient-Centered Care.
Jamb Care Mngmnt. 2009; 32: 44-51.
Lynn Ho, MD; Adam Swartz, MD; John H. Wasson, MD. The Right Tool for
the Right Job: The Value of Alternative Patient Experience Measures. 2013. J Ambulatory Care Manage Vol. 36, No. 3, pp. 241–244
A single measure of quality is similar to ratings by clinicians and patients (CAHPS)
Health Confidence and Collaborative Care Between Clinicians and Patients
Wasson JH, Johnson DJ, and Mackenzie T. The Impact of Primary Care
Patients’ Pain and Emotional Problems on their Confidence with Self-Management. Jamb Care Mngmnt. 2008;31: 120-127.
Wasson JH, Johnson DJ, Benjamin R, Phillips J, et al. Patients Report
Positive Impacts of Collaborative Care. J Ambulatory Care Manage. 2006; 29(3): 199-206.
Lynn Ho, MD; John Watt Haresch, MD; Mark Nunlist, MD; Adam Schwarz,
MD; John H. Wasson, MD. Improvement of Patients’ Health Confidence: A Comparison of 15 Primary Care Practices and a National Sample. 2013. J Ambulatory Care Manage. Vol. 36, No. 3, pp. 235–240
Wasson JH, Benjamin R, Johnson D, Moore LG, and Mackenzie T. Patients
Use the Internet to Enter the Medical Home. J.Amb.Care.Mgmt. 2011;34:38-46
Wasson JH. A Patient-Reported Spectrum of Adverse Health Care
Experiences: Harms, Unnecessary Care, Medication Illness, and Low Health Confidence. 2013. J Ambulatory Care Manage: Vol. 36, No. 3, pp. 245–250
Wasson JH and Coleman EA. Health Confidence: A simple, essential
measure for patient engagement and better practice. Family Practice Management Sept.-Oct 2014.Pages 8-12.
Health confidence as a simple, actionable measure should be a central focus for health care; when health confidence is high patient outcomes are good and wasteful care can is avoided; at practice level information quality is the strongest driver of health confidenceè

When HowsYourHealth is Used, What Happens

Topic Reference(s) Comment
Randomized controlled trials
Wasson JH, Stukel TA, Weiss JE, Hays RD, Jette AM, Nelson EC. A Randomized Trial Of Using Patient Self-Assessment Data To Improve Community Practices. Effective Clinical Practice 1999; 2:1-10

Ahles TA, Wasson JW, Seville JL, Johnson DJ, etal. A Controlled Trial of Methods for Managing Pain in Primary Care Patients With or Without Co-Occurring Psychosocial Problems. Ann. of Family Med 2006; 4(3):341-350
Positive impacts most apparent when clinicians act on the information provided to them
Change in Care/Quality Improvement
Moore LG and Wasson JH. Ideal Medical Practice: Improving Efficiency, Quality, and the Doctor-Patient Relationship. Family Practice Management. 2007; September: 21-24.

Eads M. Virtual Office Practice. Family Practice Management. 2007; October: 20-22.

Ho L. Seven Strategies for Creating a More Efficient Practice. Family Practice Management. 2007; September: 27-30.

Antonucci J. Helping High Need Patients Make Behavior Change. Family Practice Management. 2008; April: A6-A8

Guinn N and Moore LG. Practice Measurement: A New Way to Show the Worth of Your Work. Family Practice Management. 2008; February: 19-22.

Wasson JH, Anders GS, Moore LG, Ho L, Nelson EC, Godfrey MM, Batalden PB. Clinical Microsystems, Part 2. Learning from Micro Practices about Providing Patients the Care They Want and Need. Joint Commission Journal of Quality and Patient Safety 2008;34: 445-452

Lynn Ho, MD; John Watt Haresch, MD; Mark Nunlist, MD; Adam Schwarz, MD; John H. Wasson, MD. Improvement of Patients’ Health Confidence: A Comparison of 15 Primary Care Practices and a National Sample. 2013. J Ambulatory Care Manage. Vol. 36, No. 3, pp. 235–240
A series of articles by primary care physicians who illustrate how different components of HowsYourHealth can improve care. Includes several before-after comparisons. Not published are the ways practices use results to enhance reimbursements and attain high levels for "medical home" certification.

Observation From Wide Use of HowsYourHealth

Topic Reference(s) Comment
Communities and Employers
Wasson JH, James C. Implementation of a web-based interaction technology to improve the quality of a city's health care. J Amb Care Mgmt 24: 1-12, 2001.

Luce P, Phillips J, Benjamin R, Wasson JH. Technology for Community Health Alliances. J. Amb. Care Managem. 2004;27(4): 366-374
Samples from different settings. At the community, HowsYourHealth can be customized to refer patients to resources by zip code; the hospital and frail versions are used widely; problems-solving and decision-supporting tools are used widely as well.
Schools
Bracken AC, Hersh AL, Johnson DJ. A Computerized School-Based Health Assessment with Rapid Feedback to Improve Adolescent Health. Clin. Pediatrics 1998;677-683.
 
Hospital
Lepore M, Wild D, Gil H, Lattimer C, Harrison J, Woddor N and Wasson JH. Two Useful Tools To Improve Patient Engagement and Transition from theè Hospital. 2013. J Ambulatory Care Manage. Vol. 36, No. 4, pp. 338-344.
 
Wall Street Journal Readers
Wasson JH. Who is in charge? Even affluent patients suffer consequences
of fragmented care. JAmb CareMngmnt. 2008;31: 35-36.
 
National Examples
Yasaitis L, Fisher ES, Mackenzie T, and Wasson JH. Health Care Intensity is Associated with Lower HealthCare Quality by Adults. J.AMB.CARE.MGMT. 2009; 32: 226-231

Karagas MR, Wasson JH A World Wide Web-based survey of nonmedical tattooing in the United States. J Am Acad Dermatol. 2012 Jan;66(1):e13-4.

Wasson J. Regular Exercise is Strongly Associated with Anticipated Success for Reducing Health Risks. 2014. J. Ambulatory Care Management; 37: 273-276

Wasson JH and Benjamin R. How’s Your Health. Free on line.
 

Making HowsYourHealth Better By Testing and Adapting

From early design principle (immediate feedback and service as default being paramount) we test items, numbers of items, and the content of feedback and service in different settings and populations. A few illustrations are provided below. In all reports and assessments HowsYourHealth.org and HealthConfidence.org bring attention to disparities in care associated with income. (Wasson J, Benjamin R. Postscript. Health Disparity and Collaborative Care. J Ambulatory Care Manage. 2006; 29(3): 233-234).