Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

Patients are notoriously nonadherent to suggestions for lifestyle change made by their physicians, e.g., weight reduction, increase in exercise, smoking cessation. What evidence exists that a graphic depiction of risk of non-adherence to behavior change vs. usual care (physician admonition without graphic depiction) results in greater adherence to weight reduction, diabetes management, blood pressure management and tobacco cessation recommendations from their physician?

For example, for persons with diabetes, graphic depictions can show each increase of glycated hemoglobin of 1% increases the likelihood of a cardiac event by 10%.

If there is limited evidence, can new research consider the use of graphic depictions with physician recommendation vs. usual care (physician admonition without graphic depiction) and the rate of patient’s adherence to life style change recommendations?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

See above.

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Men and women with higher risks of high blood pressure, obesity, tobacco use, and cardiovascular disease.

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

• Patients would take preventive suggestions, implement life style changes, and improve health status, indicators, and outcomes.
• Patient written material and other translational materials would have increased impact at conveying the importance of life styles improvements.
• Health screenings and health risk appraisals would result in suggested behavior modification.
• Care management programs could have increased positive effect on motivating patient to follow physicians’ recommendations.
• Incentive programs by payers, employers and purchasers or health care could be designed to encourage life style changes by members and employees.
• Cost and time savings to physicians/providers and health care system, in general.

Describe any health-related risks, side effects, or harms that you are concerned about.

• Morbidity and mortality from modifiable risk factors.
• Patients’ health outcomes would decline (weight gain, increased blood pressure, increased cholesterol).

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Cardiovascular disease, including stroke and hypertension
• Diabetes mellitus
• Obesity
• Pulmonary disease/asthma

AHRQ Priority Populations

• Low income groups
• Minority groups
• Women

Federal Health Care Program

• Medicaid
• Medicare

Importance

Describe why this topic is important.

Physicians often make recommendations to patients from a risk reduction standpoint to make basic life style changes during a preventive medical exam. Recommendations like lose weight, quit smoking, exercise more etc are frequently suggested, yet many patients do not make and/or stick to the behavior changes as prescribed.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

UnitedHealthcare has health risk appraisals where new members get $100 for completing self-screening. The Company sends informational material to members based on responses and potential health risks. I am interested in more effective teachable moments and formats to display evidence-based correlations between behavior change and improved health status.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

See above.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

• Payers could improve use of health risk appraisals of new members.
• Informational brochures on specific diseases would increase changes of motivating patients to make life style changes.
• Physician could use evidence and/or related translational material for a teachable moment with a patient
• Patient would make life style change recommendations from physician and avoid future worsened health conditions

Describe the timeframe in which an answer to your question is needed.

As soon as practical.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

• Payers could improve use of health risk appraisals of new members.
• Informational brochures on specific diseases would increase changes of motivating patients to make life style changes.
• Physician could use evidence and/or related translational material for a teachable moment with a patient
• Patient would make life style change recommendations from physician and avoid future worsened health conditions

Are you making a suggestion as an individual or on behalf of an organization?

Organization

Please tell us how you heard about the Effective Health Care Program