About HowsYourHealth

© 1997-2022 FNX Corporation
and Trustees of Dartmouth College.
All Rights Reserved.

About HowsYourHealth

and

Permission to Use HowsYourHealth Tools

About HowsYourHealth.org

The results of controlled trials, field tests and suggestions of hundreds of people like you have advanced the development of HowsYourHealth.org. HowsYourHealth automatically provides you with health information and several tools that are proved to help people become more Health Confident, improve their health, and improve their health care.

The latest version of HowsYourHealth.org (and HealthConfidence.org) emphasizes the importance of Health Confidence. It also encourages the use of the HYH Personal Health Plan (so that you can easily keep track of and share what matters to you).

We strive to improve the design and function of HowsYourHealth. Therefore, we appreciate your suggestions.

Please write suggestions and comments to the WebMaster

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.

*HowsYourHealth* has two parts:

the questions you are asked
the information you receive after you answer the questions.

We use four methods to make sure that both of these parts are accurate:

research
word review and reading level
information review
update of information

Research

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.

Word Review and Reading Level

We have the Words Reviewed by non-medical persons. Teenagers and adults reviewed the words during the research and suggested changes to make the words easier to understand. Language translations are checked by at least two persons to make sure they are correct. However, despite our best efforts, some persons will need help answering the questions or reading the information. After extensive testing, *HowsYourHealth.org* was designed to be easy on eyes, easy to navigate, and easy for even the slowest computer to read.

Survey Items Reading ease: A higher score indicates easier readability; scores usually range between 0 and 100. Flesch-Kincaid Reading Ease = 69.6. A grade level (based on the USA education system) is equivalent to the number of years of education a person has had. A score of around 10-12 is roughly the reading level on completion of high school. Text to be read by the general public should aim for a grade level of around 8. Flesch-Kincaid Grade Level =7.2; Average Grade Level from multiple scoring methods = 8.3.

Information Review

The information has been designed and tested to help you take better care of yourself and help you get better health care. The research shows that the information must be set up in certain ways to best help you and a doctor or nurse communicate well or "get on the same page". The information is much less medically detailed than that provided by MedlinePlus (or other web sites) that are designed to give you the latest and best medical information for a specific disease or problem.

We have tried to make HowsYourHealth error free. However, those involved in its preparation can not warrant that all of the information is accurate and complete. When you use HowsYourHealth as a guide for your health and medical care, be sure to discuss any questions about it with your doctor, nurse or other health care worker.

The information provided on HowsYourHealth is designed to support, not replace the relationship that exists between a patient/site-visitor and his/her physician.

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The Trustees of Dartmouth College licensed FNX Corporation to make this approach available to health professionals and others concerned about the health of the population.

For additional information about customized use, contact the webmaster.

Updates

Except for the correction of errors that is done immediately, updates of the questions and information are performed annually. The latest update was in January, 2021. For persons aged 13 or older, the sources for updates are:

The Journal of the American Medical Association
The New England Journal of Medicine
The British Medical Journal

Advertising and Sponsorship

HowsYourHealth accepts no advertising of any type. Therefore there is no conflict of interest. HowsYourHealth is supported voluntarily by fees from sponsoring doctor's offices, health systems, and businesses.

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, 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 confidence

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 the 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).

Wasson JH, Jette AJ, Johnson DJ, Mohr JJ, Nelson EC. A Replicable and Customizable Approach To Improve Ambulatory Care and Research. J Ambulatory Care Management 1997;20(1):17-27.
Hess AM, Nelson EC, Johnson DJ and Wasson JH. Building and Idealized Measurement System to Improve Clinic Office Practice Performance. Manag Care Quart 1999;7:1-12
Wasson JH, Bartels S. CARE Vital Signs Supports Patient-Centered Collaborative Care. Jamb Care Mngmnt. 2009;32: 56-71.
Wasson JH, Baker NJ. Balanced Measures for Patient-Centered Care. Jamb Care Mngmnt. 2009;32: 44-51
Wasson JH, Forsberg H, Lindblad S, Mazowita G, McQuillen L, Nelson EC. The Medium is the (Health) Measure: Patient Engagement Using Personal Technologies. J.Amb.Care.Mgmt. 2012; 35:109-117.
American College of Physicians (www.MedicareHealthAssess.org)
Academy of Family Practice (www.MedicareHealthAssess.org)
The Agency for Health Care Policy and Research (http://www.ahrq.gov/professionals/prevention-chronic-care/improve/system/health-assessments/)

Permission to Use HowsYourHealth Tools

All of the tools of HowsYourHealth are PUBLICLY, available without
charge (for non-commercial purposes). All patients and members of the
public can use HowsYourHealth tools at any time. Health professionals
may also use the HowsYourHealth tools without charge but if the health
professional wishes to test and customize the tools they are required
to register.

Commercial Purposes

If there is a commercial purpose ( a use for which there will be
either a direct or indirect charge and/or a transfer of revenue)
please contact the webmaster with a brief description regarding the
use of the tool or tools. We review commercial requests on a case by
case basis. However, requests for linkages of HowsYourHealth tools to
advertise commercial products and services is not allowed under any
circumstances.