HEALTH-STATUS MEASUREMENT - IMPLEMENTATION STRATEGIES

The creation of valid instruments of health status measurement does not guarantee their use in the clinical setting. Traditional continuing medical education has not been shown to effect physician behavioral change. Examination of the literature on the dissemination of new technology underscores the need for the acceptance and use of new methods by local opinion leaders whose behavior serves as a model for their colleagues. Since health status measurement will require a new way of evaluating the patient visit and the creation of new provider behaviors, widespread implementation will require the recruitment of local clinical leaders to serve as spokesmen for reconsideration of office care procedures. Advocates of health status measurement should seize on a variety of opportunities to disseminate their work. Medical school curricula in courses such as physical diagnosis could expose different approaches to the patient encounter to a new generation of physicians in a fairly painless and seamless manner. Academic practice plans, by virtue of their increasing trend to centralization, could commit to patient-oriented data collection-if not for instructional purposes, then for the overall health of the delivery system. The instruction of nurses and paraprofessionals in the collection of these data could expand the measures and help drive the system when physicians are not embracing the technology. There is need to exploit the enhanced capacity of computer hardware and software in the service of efficient data collection and trend analysis of health status. Some of these data could be required by third-party payers, but it is crucial that health status measurement advocates account for resource cost associated with the data. Finally, clinical researchers must incorporate health status measurement into new clinical algorithms, so that community practitioners could interpret and use the data for therapeutic purposes. The health status measurement community now have products to offer the health care system; successful implementation will require the marketing of this material to ensure acceptance and use.