Saturday, April 20, 2013

An Innovative Proposal:  Routine Health Measurements  in Primary Care Practices and in Wellness Programs
When you can measure what you are speaking about it, and express it in numbers, you know something about it; but when you cannot express it in numbers, your knowledge is of a meager and unsatisfactory kind; it may be the beginning of knowledge, but you,  scarcely in your thoughts, advance to the state of science.
Lord Kelvin (1824-1907), Popular Lectures and Addresses
Before I explain my proposal,  consider these facts.
·         One of three Americans is hypertensive; one of five has prediabetes  or diabetes; one of three is, or soon will be, overweight or obese;  one of two males over 65 and two of five females over 65 are taking statin drugs.  Most Americans consider themselves in fair or good health, but  the things just mentioned are precursors or evidence of chronic disease.

·         Americans  are extremely health conscious. Most of us, in one form of another, take vitamins,  herbs, diet supplements, or anti-oxidants  to stay healthy or ward off disease.  We flock to health food stores. More and more of us consume only organic foods.   We regularly visit fitness outlets with their fitness machines and fitness workouts.

·         Americans and their employers  understand that fitness and leanness strongly indicate health and that daily exercise and a proper diet are desirable pathways to health, and, increasingly , to gainful employment.   Among employers,  health and wellness programs are proliferating across corporate American and are establishing criteria for hiring and firing based on health measurements and improvement of those measurements.

·         Most Americans understand  IQ (intelligent Quotient), with a normal range of 80 to 120, with 80 being low normal intelligence and 120 being high normal intelligence.  Most of us understand too, that you if can numerically measure a health problem – high blood pressure, overweight,  elevated blood sugar or cholesterol – you can manage it- through exercise, drugs, or behavioral changes, such as smoking cessation.

·          Most Americans who visit a primary care doctor  have  blood pressure taken,   weight recorded,  height measured,  and routine blood tests done  – metabolic and lipid profiles and complete blood counts.
My Proposal
My proposal is straightforward -   Have primary care physicians, and wellness program managers,   use routine physical measurements – blood pressure, body mass index calculated from weight and height,  waist circumference,   hemoglobin A1C, and blood lipid levels – serve as the basis for an algorithm  that would issue a letter to the patient  containing their  HQ (health quotient)  which would classify patients  as being in superb health (HQ of 120 or more), average health (80 to 120), subpar health (below 80).,  or health needing primary care evalution (50 or below)
The letter would either congratulate patients on their good health, encourage  them, tell them  how to maintain it, or improve their health.   In my work as a clinical pathologist,  I developed an HQ algorithm as part of corporate wellness programs and sent letters to each patient explain what the HQ meant , what to do about it, including seeing a doctor if HQ values were subpar.
Roughly 50%  of 4200 state government employees with measured HQs had subpar  values ,  many of whom were unaware of their health problem.  The average HQ was 77 – 30% had high BP. 35 % were overweight, 5% had glucoses of 120 or more, and 8% wre in imminent danger of a heart attack (total cholesterol/HDL ov 13.5 more) Doctors treating these patients appreciated the patient self-referrals and reasons for seeing them.  I have explained this program at greater length in my 2007 book, Innovation-Driven Health Care: 34 Key Concepts for Transformation (Jones and Bartlett).
Monetary Incentives
Now, other than the overall goal of reducing health costs.  there is  monetary incentive for organizations  adopting and implementing HQ programs.
Richard Merkin, MD, president and CEO of Heritage Provider Network,  has announced his organization will offer at lest three $100,000 prizes to most innovation teams that solve health puzzles.   The public and a panel of judges will pick the winners.   Bill Frist, MD, former Senate Majority Leader, will co-sponsor the event along with the Advisory Board Company.
Why not a prize for measuring total wellness in the primary care physicians office or in those thousands of wellness programs being set up by companies to measure and improve the wellness of their employees? 
The idea is simple and straightforward and can be done almost in any health care setting:
1)       Measure a person’s  height, weight, blood pressure, and waist size.

2)      Measure the patient’s hemoglobin A1C ( a reflection of their blood sugar over the last three months),  and  blood lipids (total cholesterol,  LDL cholesterol, HDL cholesterol,  triclyerides, and LDL/cholesterol )

3)      Issue a report to the patient telling them the meaning of their health measurement,   telling them how to maintain, improve, or correct their problem, if any, and to visit their primary care physician, if indicated.

Tweet:  The Health Quotient (HQ) measures the overall health of a person and usefully serve as a basis for continuous health improvement.


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