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Environmental Scan - Health Risk Appraisals in Primary Care


Final report of environmental scan and expert panel meeting to learn more about how health risk assessments are being used in primary care and to identify the research gaps related to HA utilization and outcomes.

Environmental Scan Methodology

Relevant literature and other materials were identified by the study team. Some documents were obtained from the Agency for Healthcare Research and Quality (AHRQ) and personal contacts. Many came from EBSCOhost or other online sources. Others are from the National Library of Medicine, Johns Hopkins library, and interlibrary sources. Information was extracted with proper bibliographic reference, sorted by topic, and then synthesized.

The relevance of international literature was discussed with AHRQ. While some non-English-language material might be acceptable, the difference in health care systems would be problematic. AHRQ therefore recommended that these resources be included on a case-by-case basis. Research conducted in the United States was the principal focus.

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Inclusion and Exclusion

Strategies that were implemented to identify relevant information include:

  • Held discussions with AHRQ officials to identify pertinent studies already known to AHRQ.
  • Conducted Internet journal searches through BiomedCentral and through EBSCOhost Health-Related Journals, with simultaneous search of MEDLINE, Biomedical Reference Collection: Corporate; Electronic Journal Service E-Journals; Nursing and Allied Health Collection: Comprehensive; PsychINFO, Psychology and Behavioral Sciences Collection; PsycARTICLES; and SocIndex. Essentially the same search terms were used with each search engine, using Boolean search algorithms as follows: (health risk appraisal*) NOT (test OR tests OR testing OR questionnaire* OR research instrument*) AND (utilization OR visit*) AND (longterm care OR long term care OR chronic care OR primary prevention OR preventive medicine OR preventive services) AND (health status indicators OR health risk appraisal* OR visit* OR utilization OR primary OR physician*) AND ((research instrument* OR questionnaire* OR test OR tests OR testing) AND (hra OR health risk appraisal*)).
  • Scanned abstracts to determine relevant articles before retrieving full text.
  • Conducted Internet searches with Google, Google Scholar, and Scirus of non-journal literature (unpublished reports, dissertations, etc.). These searches used the Booleans from the journal abstract search or more specific terms geared to finding ancillary materials related to published articles or materials identified through networking.
  • Hand-searched the reference lists of relevant items.

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Key Informant Interviews

Telephone discussions were conducted with nine key informants identified by AHRQ, the study team, the literature, and networking with colleagues. The interviewees were selected in consultation with AHRQ.

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List of Key Informants

  • Bruce Bagley (American Academy of Family Physicians).
  • Ron Goetzel (Thomson Reuters and Emory University).
  • David Grossman (Group Health Cooperative and U.S. Preventive Services Task Force).
  • Robert Harmon (Florida County Health Department).
  • James Mold (Family and Preventive Medicine, University of Oklahoma).
  • Zsolt Nagykaldi (University of Oklahoma).
  • Nico Pronk (Health Behavior Group, HealthPartners).
  • Phil Renner (National Committee for Quality Assurance).
  • Robin Soler (Centers for Disease Control and Prevention).

An open-ended discussion guide was approved by AHRQ. Questions were sent to respondents before the interviews to help them prepare and the interviews lasted up to 1 hour each.

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Expert Panel Meeting

An expert panel was recruited to further inform the study. The panel met for a full day at AHRQ on March 11, 2009. The panel received the environmental scan report prior to the meeting. Two people took detailed notes at the panel meeting and the proceedings were taped.

Panel members included:

  • David Anderson, Ph.D., LP (Senior Vice President & Chief Health Officer, Staywell Health Management, St. Paul, MN).
  • Ron Goetzel, Ph.D. (Vice President, Consulting & Applied Research, Thomson Reuters, Washington, DC, and Research Professor & Director, Institute for Health and Productivity Studies, Rollins School of Public Health, Emory University).
  • David Grossman, MD, MPH (Medical Director, Preventive Care, Group Health Cooperative, Seattle, WA and U.S. Preventive Services Task Force).
  • Linda Kinsinger, MD, MPH (Chief Consultant for Preventive Care Services, VA National Center for Health Promotion and Disease Prevention, Durham, NC).
  • Michael Lefevre, MD (Professor, Family and Community Medicine, University of Missouri—Columbia and U.S. Preventive Services Task Force).
  • Zsolt Nagykaldi, Ph.D. (Assistant Professor of Research, University of Oklahoma Health Sciences Center).
  • Nico Pronk, Ph.D., FACSM (Vice President & Health Science Officer, Journeywell, and Senior Research Investigator, HealthPartners Research Foundation, Minneapolis, MN).
  • Tricia Trinite, MSPH, ANP-BC (Prevention Dissemination & Implementation, AHRQ).
Page last reviewed August 2010
Internet Citation: Environmental Scan - Health Risk Appraisals in Primary Care: Methodology . August 2010. Agency for Healthcare Research and Quality, Rockville, MD.


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