As part of SETMA’s Patient-Centered Medical Home, we annually complete five questionnaires for each patient seen to assess the following:
- Fall Risk
- Pain Assessment
- Functional Assessment
- Wellness
- Stress
The standard is that each should be completed on all patients at least once a year and more frequently if a change in conditions dictates. The Fall Risk should be completed on all patients over 50 and on younger patients who as a result of chronic condition are at risk of falling.
Provider performance on these questionnaires is publicly reported below. The content of the questions are as follows:
![http://jameslhollymd.com/epm-tools/images/Patient-Centered-Medical-home-annual-Questionaires_clip_image002.jpg](http://jameslhollymd.com/epm-tools/images/patient-centered-medical-home-annual-questionaires_clip_image001.jpg)
Once the Fall Risk Assessment is completed, the provider should, on the basis of the score, access the “Guidelines for Fall Precaution” and prepare a plan for preventing falls.
![http://jameslhollymd.com/epm-tools/images/Patient-Centered-Medical-Home-Annual-Questionaires-content_clip_image004.jpg](http://jameslhollymd.com/epm-tools/images/patient-centered-medical-home-annual-questionaires_clip_image002.jpg)
![http://jameslhollymd.com/epm-tools/images/Patient-Centered-Medical-Home-Annual-Questionaires-content_clip_image006.jpg](http://jameslhollymd.com/epm-tools/images/patient-centered-medical-home-annual-questionaires_clip_image003.jpg)
Source -- Global Assessment of Functioning (GAF) Scale -- American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). doi:10.1176/appi.books.9780890423349.
![http://jameslhollymd.com/epm-tools/images/Patient-Centered-Medical-Home-Annual-Questionaires-content_clip_image008.jpg](http://jameslhollymd.com/epm-tools/images/patient-centered-medical-home-annual-questionaires_clip_image004.jpg)
(Source: NIH. (2007). National Institutes of Health. Pain Intensity Scales Retrieved January 17, 2007NIH. (2007). National Institutes of Health. Pain Intensity Scales Retrieved January 17, 2007
![http://jameslhollymd.com/epm-tools/images/Patient-Centered-Medical-Home-Annual-Questionaires-content_clip_image010.jpg](http://jameslhollymd.com/epm-tools/images/patient-centered-medical-home-annual-questionaires_clip_image005.jpg)
![http://jameslhollymd.com/epm-tools/images/Patient-Centered-Medical-Home-Annual-Questionaires-content_clip_image012.jpg](http://jameslhollymd.com/epm-tools/images/patient-centered-medical-home-annual-questionaires_clip_image006.jpg)
The Stress Assessment based on the Score
>=80 points |
You have an excellent resistance to stress. |
>=60 points |
You may be somewhat vulnerable to stress. |
<60 points |
You may be seriously vulnerable to stress. |
(Source: University of California, Berkley Wellness Letter, August 1995. Scale Developers: Lyle Miller and Alma Dell Smith of Boston University Medical Center)
![http://jameslhollymd.com/epm-tools/images/Patient-Centered-Medical-Home-Annual-Questionaires-content_clip_image014.jpg](http://jameslhollymd.com/epm-tools/images/patient-centered-medical-home-annual-questionaires_clip_image007.jpg)
![http://jameslhollymd.com/epm-tools/images/Patient-Centered-Medical-Home-Annual-Questionaires-content_clip_image016.jpg](http://jameslhollymd.com/epm-tools/images/patient-centered-medical-home-annual-questionaires_clip_image008.jpg)
Wellness Assessment results based on the Score
< 5 points |
Poor |
5-9 points |
Fair |
10-19 points |
Good |
20-29 points |
Very good |
>=30 points |
Excellent |
(Source: University of Wisconsin, Health Promotion and Human Development Department. Developers: Anne Abbott, Jane P. Jones and John Munson)
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