Prescription for Health Toolkit

The tools below were developed by the practice based research networks (PBRNs) and other collaborators funded in Round 1 and 2 of Prescription for Health.

For specific questions about the components, development, or use of these tools, please refer to the appropriate contact person.

Virginia Ambulatory Care Outcomes Research Network (ACORN)
Contact: Steven H. Woolf, MD, MPH
swoolf@vcu.edu


My Healthy Living Website: www.myhealthyliving.net
This website is a tool to help primary care doctors assist their patients live healthier lives. On it you will find information and guidance about diet, physical activity, smoking, and alcohol use. The material includes some of the best information available from major national organizations and government agencies.

Virginia Ambulatory Care Outcomes Research Network (ACORN)
Contact: Alex Krist MD MPH
ahkrist@vcu.edu

eLinkS Application to Promote Collaboration Between Clinicians and Community Resources
The eLinkS application (Electronic Linkage System) is designed to be a fast, easy, and practice-friendly means to automate referrals from clinicians to community resources and to facilitate communication using an electronic medical record (EMR). The system is designed with the belief that clinicians are very good at identifying unhealthy behaviors, counseling patients on improving them, and seeking agreement on next steps. While clinicians often lack the infrastructure, support, and expertise to provide the longitudinal intensive counseling required to help patients improve unhealthy behaviors, community resources are available. Clinicians frequently report that they do not know about these resources and do not know how to refer patients to them. Community counseling centers report difficulties and expenses with recruiting participants and frequently lack coordination with ongoing clinical care. eLinkS seeks to establish this clinician-community linkage, automate referrals, reduce staff time, and facilitate proactive counseling.

Step 1. Clinician prompt

Step 2. Clinician form

Step 3. Patient referral

Step 4. Counselors contact patient

Alabama Practice Based Research Network (APBRN)
Contact: Myra Crawford, PhD
mcrawford@uab.edu

*PDA-Based Best-Practice Protocols for Tobacco and Unhealthy Diet
These two evidence-based, best-practice protocols were mounted on personal digital assistants (PDAs) and created to guide and prompt physicians to assess and counsel patients on tobacco use and unhealthy diet at the point of care. Consisting of standardized assessments, individualized counseling, and serving as a charting aid, the protocols are easy-to-use tools for promoting healthy behaviors that can be easily integrated into routine daily practice and adapted to address a variety of health problems.

* Please contact Myra Crawford (mcrawford@uab.edu) to obtain a copy of these protocols.

Colorado Research Network (CaReNet)
Contact: Wilson Pace, MD
wilson.pace@uchsc.edu

LEAP Behavior Change Booklet
The Leaders in Behavioral Change (LEAP) booklet was created for use by practice clinicians, staff, and patients. It consists of tools to help people set, track, and attain behavior change goals, and includes:

• recommendations for increasing physical activity including use of a pedometer
• recommendations for cutting calories and changing eating habits
• tips for staying on track such as a goal planning calendar to track nutrition and activity goals
• available in English and Spanish

For Download:
LEAP Booklet - English (.DOC / Word 548 Kb)
LEAP Booklet - Spanish (.DOC / Word 596 Kb)


Colorado Research Network (CaReNet)
Contact: Perry Dickinson, MD
perry.dickinson@uchsc.edu

Connection to Health Website: www.connectiontohealth.org
This website serves to develop and assess an interactive, multiple behavior intervention for adult primary care patients addressing physical activity, healthy eating, cigarette smoking, and risky drinking, that also enhances the identification and care of depression.

Center to Enhance Child Health Network(CECH)
Contact: Ardis Olson, MD
ardis.l.olson@dartmouth.edu


PDA-Based Health Screener and Action Plan Tools for Teens
A self-administered health and risk assessment tool mounted on a personal digital assistant (PDA) for completion in the exam room prior to the health visit. The screener has 66 questions with 2 age versions (11-14 yrs and 15-19 yrs), and it takes approximately 7 – 11 minutes to complete. It assesses nutrition, exercise, tobacco, and alcohol use as well as other health concerns and psychosocial risks included in the Guidelines for Adolescent Preventive Services. The screen has branching pathways that assess readiness to change, risk behaviors, and other problematic behaviors. Counseling tools were also developed to facilitate patient-centered, stage-based negotiations of a teen’s personal action plan.

For Download:
Action Plan Handout (.DOC / Word 428 Kb)

Dartmouth COOP Project (COOP)
Contact: John Wasson, MD
John.H.Wasson@Dartmouth.EDU


How’s Your Health Website: www.HowsYourHealth.org
This website was designed as clinical improvement systems to generate health reports based on questionnaire responses, identify problems, provide health education, disease management and stimulate improvement. The real-time, on-line data summary displays the needs and process of care for respondents. The summary data can be used to compare communities, patients, and the performance of physicians and medical care organizations. In this way the website serves the needs of the patient, the "front line," and the "back office." HowsYourHealth has five major components:

• patient/community self-assessment of health care and needs
• education tailored to the respondents needs
• feedback to physicians
• on-line options for retrieving aggregate information
• options for disease management, customizing questions, e-mail of information from patient's computer to a doctor's office, exporting patient information to a registry
• available in English and Spanish

Great Lakes Research Into Practice Network (GRIN)
Contact: Jodi Holtrop, PhD
jodi.holtrop@ht.msu.edu


Survey Instruments to Assess Systematic use of 5As in Practice
These instruments were developed as part of a project to test a consultation model of support on the delivery of preventive services in primary care practices. The consultation model encourages practices to increase their delivery of the 5As counseling sequence (ask, advise, assess, assist and arrange) for tobacco use, physical activity, diet, and risky drinking during appropriate medical visits. Trained nurse consultants used pre and post chart audit instruments and a structured abstraction form to assess the rates of documentation of delivery of the 5As.

For Download:
Pre Practice Assessment Instrument (.DOC / Word 72 Kb)
Post Practice Assessment Instrument (.DOC / Word 76 Kb)
Chart Audit Form (.DOC / Word 44 Kb)

Midwest Nursing Consortium Research Network (MNCCRN)
Contact: Laura Anderko, RN, PhD
landerko@uwm.edu


*The Wellness Club Instructor Manual
An instructor manual was developed for the “Wellness Club” curriculum. This curriculum is tailored for low-income, culturally diverse clients at risk for poor health due to poor diet and limited physical activity. The curriculum is designed for group teaching and includes eight lessons:

• Class1: Introduction and self-assessment for health improvement
• Class 2: Healthier eating and physical activity
• Class 3: Benefits of physical activity
• Class 4: Team building for a healthier you
• Class 5: Hypertension – How to lower your numbers and chance of stroke
• Class 6: Fiber up and cholesterol down
• Class 7: Giving it up
• Class 8: Celebration/ Recognition!: Future direction for a new lifestyle

* Please contact Laura Anderko (landerko@uwm.edu) or Claudia Bartz (cbartz@uwm.edu) to obtain a copy of this manual

North Carolina Family Medicine Research Network (NCFMRN)
Contact: Katrina Donahue, MD, MPH
kdonahue@med.unc.edu

Health Behavior Assessment Software
This interactive software program seeks to promote screening, counseling, community resource use, and behavior change in primary care practices by targeting physical inactivity, smoking, unhealthy diet and risk drinking in adults and adolescents using Tablet PC technology.

New England Clinicians Forum (NECF)
Contact: Jennifer Granger, MPH
jgranger@ctpca.org

Health & Lifestyle Screening Instrument and Workshop for Implementing Screening and Brief Intervention Services for Smokers and At-risk Drinkers
A 10-question screening instrument was developed to identify smokers and at-risk drinkers. The instrument is available in English and Spanish.

A workshop curriculum was developed for a 3.5 hour training of primary care clinicians on the implementation of a screening and brief counseling intervention for smokers and at-risk drinkers. The curriculum includes materials about:

• health risks associated with tobacco and heavy drinking
• key ingredients of effective screening and brief counseling
• role play activities
• strategies for successful implementation

For Download:
Health & Lifestyle Screen - English (.DOC / Word 144 Kb)
Health & Lifestyle Screen - Spanish (.DOC / Word 148 Kb)

Brief Intervention Guide - Risky Drinking - English (.DOC / Word 120 Kb)
Brief Intervention Guide - Risky Smoking - English (.DOC / Word 76 Kb)

Feedback Report for Patients - Risky Drinking & Smoking - English
(.DOC / Word 140 Kb)

Feedback Report for Patients - Risky Drinking - Spanish (.DOC / Word 100 Kb)
Feedback Report for Patients - Risky Smoking - Spanish (.DOC / Word 64 Kb)

Curriculum for Implementing Screening and Brief Intervention Services for Smokers and at-risk Drinkers in Primary Care Settings ( .PPT / PowerPoint 13.1 Mb)

New York City Research and Improvement Networking Group (NYCRING)
Contact: Diane McKee, MD, MS
mckee@aecom.yu.edu

FLAIR Lifestyle Screener
The FLAIR survey (Family Lifestyle Assessment of Initial Risk) was designed to gather information during a 2 to 4 year-old well-child visit to screen families for risk behaviors associated with diet, physical activity, and smoking.

For Download:
FLAIR Screener (DOC/ Word 56Kb)

Oklahoma Physicians Resource/Research Network (OKPRN)
Contact: James W. Mold, MD, MPH
James-Mold@ouhsc.edu

Screening and Very Brief Interventions Tools to Promote Healthy Lifestyles
The following products were designed to help primary care practices help patients to stop smoking, adopt healthy diets and exercise, and stop risky use of alcohol. They include screening tools for use by the nurse or medical assistant, and assessment and brief intervention by the clinician.

For Download:
Guide to Screening and Very Brief Interventions (DOC/ Word 30 Kb)
Screening Items for Behaviors (.DOC/ Word 33 Kb)
Smart Patients Guide to Healthy Living (.DOC/ Word 36 Kb)
Food and Activity Log Sheet (.DOC/ Word 60 Kb)

Pediatric Pittsburgh Network (PitNet)
Contact: Ellen Wald, MD
Ellen.Wald@chp.edu

*Educational Handouts for Parents and Assessment Instruments of Knowledge about Pediatric Overweight
An educational handout was developed as a guide for parents to help kids increase healthy eating and physical activity. The 12-page handout contains information about weight measurement including BMI, healthy foods and making good food choices, portion size, recommendations for physical activity, tips for adopting a healthy lifestyle, meal plans, and online resources. The Habit Book contains goal setting materials, food and activity logs.

Three instruments were developed to assess knowledge of overweight and its treatment from providers (27 items), nurses or health educators (40 items), and parents (16 items). An additional instrument was developed to assess parents’ perceptions of overweight in their children and accompanying guidelines for clinicians’ review of parent perceptions.

* Please contact Ellen Wald (Ellen.Wald@chp.edu) or Lin Ewing (EwingLJ@upmc.edu) to obtain a copy of these educational and assessment tools

Pediatric Practice Research Group (PPRG)
Contact: Helen Binns, MD, MPH
hbinns@northwestern.edu


Online Resources on Child Nutrition and Physical Activity for Primary Care Providers and Parents: www.childrensmrc.org/pprg/resources/

This website contains educational resources for primary care providers that include:

• Health for a Lifetime: A reference manual for primary care for the prevention and management of childhood obesity
• educational handouts for families in English and Spanish for normal weight and overweight children from 0 months to adolescence, and for underweight children 2 years and older
• male and female percent of ideal body weight (%IBW) growth charts for children 0 – 20 years. Available in black & white and in color for both metric and English units

Prescription for Health Expenditures Study Steering Committee
Contact: Maribel Cifuentes, RN
Maribel.cifuentes@uchsc.edu

Templates for Collecting and Calculating Expenditure Data in Primary Care Interventions
This set of standardized tools (Figure 1, Tables 1, 2, and 3) were created for the collection of expenditure data in primary care practices during three phases of a behavioral change intervention (baseline, steady state mid-point, and steady state end-point). The user’s guide provides step-by-step instructions on the use of these tools. The tools were developed to arrive at credible estimates of start-up and incremental expenses incurred by practices to implement their Prescription for Health interventions. The tools were not developed to be used as data collection/calculations instruments to undertake a full-fledged cost-benefit or cost-effectiveness study.

For Download:
Data Collection Guide (.PDF 1.38 Mb)
Baseline Collection Tools (.XLS 47 Kb)
Steady State (mid-point) Collection Tools (.XLS 51 Kb)
Steady Stat (end-point) Collection Tools (.XLS 47 Kb)
Reporting Tool (.XLS 22 Kb)
Additional Resources (.PDF 160 Kb)

Research Association of Practices (RAP)
Contact: Susan Flocke, PhD
susan.flocke@case.edu

ARCH Website: www.arch2healthyhabits.org
This website was designed to connect patients of primary care practices in Cleveland, OH to resources for living a healthier lifestyle including:

• community programs in Cuyahoga County for weight loss, exercise, diet and nutrition, and quitting smoking
• information about diet, exercise, smoking, & your health
• guides and action plans to help change health behaviors
• healthy behavior tips, quizzes, and calculators
• website links where you can talk to others trying to change health behaviors

Virginia Practice Support and Research Network (VaPSRN)
Contact: Scott Strayer, MD, MPH
SMS6U@hscmail.mcc.virginia.edu

*MLIT Software Program for Handheld Computers
The Modular Lifestyle Intervention Tool (MLIT), a novel software program for handheld computers was designed to improve clinicians’ ability to provide patient-tailored counseling about smoking cessation at the point of care. The MLIT’s theoretical underpinning is the Transtheoretical Model (TTM) of health behavior change. The MLIT guides the identification of the patient’s current “stage” and assists clinicians with stage-based smoking cessation counseling. Each stage is linked to scripted motivational interviewing (MI) and stage- relevant clinical content. The tool also contains local and national resources for smoking cessation follow-up (i.e., National Cancer Institute’s smoking quitline telephone number).

• Main Screen Subject Files (Table of Contents)
  --precontemplation
  --contemplation
  --preparation
  --action
  --maintenance
  --relapse
  --motivational interviewing – DARES
  --stages of change tool
  --local and national resources
• Smoking Category
  --commonly prescribed smoking cessation drugs
  --second-line pharmacotherapy
  --smoking dependency assessment (Fagerström Questionnaire)
  

Main Screen Assessment	Stages of Change Recommendations	Stage-based Counseling Main Screen
Pharmacotherapy Main Screen	Smoking Cessation Resources