Using Self-Rated Health to Assess Health Risks

Generalist Physician Faculty Scholar Karen B. DeSalvo, MD, MPH, MSc, determines that a single question can identify patients at highest risk of death and their use of health care services.

    • July 15, 2009

The Problem: Health planners and policy-makers needed a feasible way to identify people with the greatest health needs, in order to appropriately target resources and health care services to those people.

Grantee Perspective: Karen B. DeSalvo, MD, MPH, MSc, assistant professor of medicine and chief of General Medicine and Geriatrics at Tulane University School of Medicine (New Orleans), was interested in improving health outcomes for vulnerable people with chronic disease. Since Tulane’s health services research group was small, DeSalvo needed to tap into a virtual group of academic scholars.

The Robert Wood Johnson Foundation (RWJF) Generalist Physician Faculty Scholars Program gave her that opportunity.

“The program gave me a chance to connect with other academics interested in the same things as I was,” said DeSalvo, a scholar from 2002 to 2007. “I have built a strong set of academic and research networks and relationships.”

DeSalvo’s network includes her national advisory committee mentor, Harold C. Sox, MD, whom she called a “rock star” of academic generalism. Working with someone so distinguished boosted DeSalvo’s confidence. Sox also gave DeSalvo practical advice about her research and her academic career.

After she became an RWJF fellow, colleagues within Tulane began to take DeSalvo more seriously as a scholar and an administrator.

DeSalvo used her fellowship to study whether one general self-rated health question could be used to assess the risk of death and use of health care services. The question, from the 36-item Medical Outcomes Study Short Form, is: "In general, how would you rate your health?” Response options were: Excellent, Very Good, Good, Fair or Poor.

DeSalvo analyzed baseline and one-year follow-up data collected from 21,732 patients who received care as part of a study conducted by the Department of Veterans Affairs. In that study, patients answered the general self-rated health question and several other questions related to their health.

Results: DeSalvo, now the C. Thorpe Ray Chair in Internal Medicine and vice dean of Community Affairs and Health Policy at Tulane, and colleagues reported the following findings in an article in Health Services Research (August 2005):

  • General self-rated health, collectable at the point of care, is comparable with longer instruments in identifying patients at increased risk of death, hospitalization or outpatient service use.
  • The measure could provide an inexpensive method to identify patients who might benefit from specific interventions such as disease or case management.

In another part of the study, DeSalvo et al. systematically reviewed 21 studies that examined the association between responses to the general self-rated health question and death (Journal of General Internal Medicine, 2006). They concluded:

  • People who rated their health as poor had a two-fold higher risk of death than those who rated their health as excellent. This was true even after the results were adjusted for functional status, depression and other illnesses.

DeSalvo continued her work with the general self-rated health question, including research conducted under three $100,000 grants running from April 2006 through March 2009 from the federal Agency for Health Care Quality and Research.

Creating Community Health Centers: While DeSalvo was in the Generalist Physician Faculty Scholars Program, Hurricane Katrina devastated New Orleans. DeSalvo helped open, and is now executive director of, two Tulane community health centers and a mobile medical unit that provide comprehensive primary care to 8,000 principally uninsured and underinsured people. Among other funding sources, is a $4.7-million grant from the Louisiana Public Health Institute and $5 million in support from the Qatar Katrina Fund. DeSalvo and colleagues are opening two more community health centers.

DeSalvo also served on many city and state committees related to Hurricane Katrina, including the Louisiana Health Care Quality Forum and the Louisiana Recovery Authority Redesign Collaborative.

RWJF Perspective: The Robert Wood Johnson Foundation established the Generalist Physician Faculty Scholars Program to create a cadre of respected generalist leaders in medical schools who would be in a position to influence curriculum, admissions and scholarship. Junior faculty in family medicine, internal medicine and pediatrics conducted research and built their careers under the guidance of mentors.

“Given the shortage of primary care physicians, we need innovative approaches to encourage medical students to choose careers in generalist fields. The Generalist Physician Faculty Scholars Program was designed to emphasize a scholarly foundation for generalism and improve the quality of the education provided to students who choose this important career path,” said Pamela S. Dickson, MBA, assistant vice president of RWJF’s Health Care Group.

When the program ended in 2008, RWJF created the Robert Wood Johnson Physician Faculty Scholars Program to strengthen the leadership and academic productivity of junior medical school faculty who are dedicated to improving health and health care. It is open not only to generalists, but all physicians.

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