Historically, patient-based measures of health have been shunned due to poor implementation results and the failure of payers to reimburse functional health assessment (FHA). FHA tools facilitate clinical practice in numerous ways including improved tracking of disease progression, more open patient-physician communication, and treatment plans according to patient’s preferences. FHA tools also enable screening for undetected disability. The unsolved mystery is that despite its apparent benefits, FHA failed to be widely adopted in the medical industry. There is little known about patients’ and physicians’ preferences for practice-based FHA which is why this study takes a qualitative approach to investigating the real concerns of the patients and the physicians. The findings of the study will lay a strong foundation for future studies into this matter.

About 56 to 57 focus groups were used to discover patients’ preferences. There are several benefits to using focus groups to investigate the matter. First of all, focus groups engage in open ended discussion and they are genuinely interested in finding a practical solution. Focus groups often reveal facts the investigators would never have doubted in the first place. Focus groups bring the stakeholders together which helps the investigators in identifying most common issues and prioritize the different needs of the stakeholders. Focus groups also allow firsthand observation of the subject matters. The investigators can ask questions and often get prompt and diverse responses which helps improve their understanding of the underlying issues. Data from physicians was obtained through semi-structured interviews. The goal was to find the perceptions of both groups regarding FHA as well as seek their suggestions to increase the use of FHA surveys in clinical practice.

Patients and physicians were chosen from Dean Health Systems Inc. in Southeastern Wisconsin. Patients sample came from the Asthma Clinic. In addition, 39 health providers representing 20 specialties were also chosen for semi structured interviews. The obstacles identified by patients included several issues with the real-time implementation of practice-based. Some patients were not sure whether the surveys were actually used by their respective physicians while the others complained that they did not receive feedback. Most patients also expressed a preference for filling out the surveys at home instead of the physicians’ offices. Patients also expressed privacy concerns. Some were dissatisfied with the structure of the surveys such as small fonts, length of the essays, and the nature of the questions such as emotional issues. The benefits of the survey as expressed by patients included increased self-awareness and knowledge.

The physicians’ complaint about the lack of resources for implementing practice-based FHA such as lack of capital, technology the need for real-time data, and the need for staff training. The physicians agreed with the patients’ privacy concerns as well as the inconvenience of filling out data before appointments.  The providers found the surveys to be unproductive; not adding much information to what is already available through patients’ histories and interviews.

In short, all three stakeholders failed to see the value in practice-based FHA and believed that FHA added more costs than benefits and thus, was not worth the time. But some physicians did credit practice-based FHA as a strong checkup tool to ensure nothing is missed out. Physicians also credited the practice-based FHA to yield qualitative data about patients and help them understand their patients’ lifestyles better.

Most providers opinioned that chronic illness is the most appropriate candidate for practice-based FHA because chronic illnesses limit one’s ability to pursue activities in life. In short, they believed that practice-based FHA is most suited to diseases that affect patients’ quality of life.