The tools below were developed by the practice based research networks (PBRNs) and other collaborators funded in Round 1 and 2 of Prescription for Health.

For specific questions about the components, development, or use of these tools, please refer to the appropriate contact person.

Prescription for Health Expenditures Study Steering Committee
Contact: Maribel Cifuentes, RN
Maribel.cifuentes@uchsc.edu

Templates for Collecting and Calculating Expenditure Data in Primary Care Interventions
This set of standardized tools (Figure 1, Tables 1, 2, and 3) were created for the collection of expenditure data in primary care practices during three phases of a behavioral change intervention (baseline, steady state mid-point, and steady state end-point). The user’s guide provides step-by-step instructions on the use of these tools. The tools were developed to arrive at credible estimates of start-up and incremental expenses incurred by practices to implement their Prescription for Health interventions. The tools were not developed to be used as data collection/calculations instruments to undertake a full-fledged cost-benefit or cost-effectiveness study.

For Download:
Data Collection Guide
Baseline Collection Tools
Steady State (mid-point) Collection Tools
Steady Stat (end-point) Collection Tools
Reporting Tool
Additional Resources

Virginia Ambulatory Care Outcomes Research Network (ACORN)
Contact: Steven H. Woolf, MD, MPH
swoolf@vcu.edu


My Healthy Living Website: www.myhealthyliving.net
This website is a tool to help primary care doctors assist their patients live healthier lives. On it you will find information and guidance about diet, physical activity, smoking, and alcohol use. The material includes some of the best information available from major national organizations and government agencies.

Alabama Practice Based Research Network (APBRN)
Contact: Myra Crawford, PhD
mcrawford@uab.edu

*PDA-Based Best-Practice Protocols for Tobacco and Unhealthy Diet
These two evidence-based, best-practice protocols were mounted on personal digital assistants (PDAs) and created to guide and prompt physicians to assess and counsel patients on tobacco use and unhealthy diet at the point of care. Consisting of standardized assessments, individualized counseling, and serving as a charting aid, the protocols are easy-to-use tools for promoting healthy behaviors that can be easily integrated into routine daily practice and adapted to address a variety of health problems.

* Please contact Myra Crawford (mcrawford@uab.edu) to obtain a copy of these protocols.

Colorado Research Network (CaReNet)
Contact: Wilson Pace, MD
wilson.pace@uchsc.edu

LEAP Behavior Change Booklet
The Leaders in Behavioral Change (LEAP) booklet was created for use by practice clinicians, staff, and patients. It consists of tools to help people set, track, and attain behavior change goals, and includes:

• recommendations for increasing physical activity including use of a pedometer
• recommendations for cutting calories and changing eating habits
• tips for staying on track such as a goal planning calendar to track nutrition and activity goals
• available in English and Spanish

For Download:
LEAP Booklet - English (.DOC / Word 548 Kb)
LEAP Booklet - Spanish (.DOC / Word 596 Kb)


Clinicians Enhancing Child Health (CECH)
Contact: Ardis Olson, MD
ardis.l.olson@dartmouth.edu


PDA-Based Health Screener and Action Plan Tools for Teens
A self-administered health and risk assessment tool mounted on a personal digital assistant (PDA) was developed for completion in the exam room prior to the health visit. The screener is 70 – 90 questions with 2 age versions (11-14 yrs and 15-19 yrs), and it takes approximately 7 – 8 minutes to complete. It assesses nutrition, exercise, tobacco, and alcohol use as well as other health concerns and psychosocial risks included in the Guidelines for Adolescent Preventive Services. The screen has branching pathways that assess readiness to change, risk behaviors, and other problematic behaviors. Counseling tools were also developed to facilitate patient-centered, stage-based negotiations of a teen’s personal action plan.

For Download:
Instructions for Importing Pendragon Forms (.DOC / Word 32 Kb)
Teen Health Screener 11-14 years (.PDF 40 Kb)
Teen Health Screener 15-19 years (.PDF 28 Kb)
Action Plan Handout (.DOC / Word 428 Kb)


UCSF/Stanford Collaborative Research Network (CRN)
Contact: Thomas Bodenheimer, MD, MPH
Tbodenheimer@medsch.ucsf.edu


Action Plan Website: www.action-plans.org
This website was designed as a virtual community for disseminating information on collaborative goal-setting for patient self-care, and sharing information among colleagues about the most useful theories and tools for helping patients achieve their health goals including:

• action plan forms in English, Spanish, and Cantonese
• patient self-management and motivational interviewing information

A report describing five interlocking strategies to help caregivers work successfully within the collaborative model is also available at http://www.chcf.org/topics/chronicdisease/index.cfm?itemID=111768

Dartmouth COOP Project (COOP)
Contact: John Wasson, MD
John.H.Wasson@Dartmouth.EDU


How’s Your Health Website: www.HowsYourHealth.org
This website was designed as clinical improvement systems to generate health reports based on questionnaire responses, identify problems, provide health education, disease management and stimulate improvement. The real-time, on-line data summary displays the needs and process of care for respondents. The summary data can be used to compare communities, patients, and the performance of physicians and medical care organizations. In this way the website serves the needs of the patient, the "front line," and the "back office." HowsYourHealth has five major components:

• patient/community self-assessment of health care and needs
• education tailored to the respondents needs
• feedback to physicians
• on-line options for retrieving aggregate information
• options for disease management, customizing questions, e-mail of information from patient's computer to a doctor's office, exporting patient information to a registry
• available in English and Spanish

Great Lakes Research Into Practice Network (GRIN)
Contact: Jodi Holtrop, PhD
jodi.holtrop@ht.msu.edu


Survey Instruments to Assess Systematic use of 5As in Practice
These instruments were developed as part of a project to test a consultation model of support on the delivery of preventive services in primary care practices. The consultation model encourages practices to increase their delivery of the 5As counseling sequence (ask, advise, assess, assist and arrange) for tobacco use, physical activity, diet, and risky drinking during appropriate medical visits. Trained nurse consultants used pre and post chart audit instruments and a structured abstraction form to assess the rates of documentation of delivery of the 5As.

For Download:
Pre Practice Assessment Instrument (.DOC / Word 72 Kb)
Post Practice Assessment Instrument (.DOC / Word 76 Kb)
Chart Audit Form (.DOC / Word 44 Kb)

Midwest Nursing Consortium Research Network (MNCCRN)
Contact: Laura Anderko, RN, PhD
landerko@uwm.edu


*The Wellness Club Instructor Manual
An instructor manual was developed for the “Wellness Club” curriculum. This curriculum is tailored for low-income, culturally diverse clients at risk for poor health due to poor diet and limited physical activity. The curriculum is designed for group teaching and includes eight lessons:

• Class1: Introduction and self-assessment for health improvement
• Class 2: Healthier eating and physical activity
• Class 3: Benefits of physical activity
• Class 4: Team building for a healthier you
• Class 5: Hypertension – How to lower your numbers and chance of stroke
• Class 6: Fiber up and cholesterol down
• Class 7: Giving it up
• Class 8: Celebration/ Recognition!: Future direction for a new lifestyle

* Please contact Laura Anderko (landerko@uwm.edu) or Claudia Bartz (cbartz@uwm.edu) to obtain a copy of this manual

New England Clinicians Forum (NECF)
Contact: Jennifer Granger, MPH
jgranger@ctpca.org

Health & Lifestyle Screening Instrument and Workshop for Implementing Screening and Brief Intervention Services for Smokers and At-risk Drinkers
A 10-question screening instrument was developed to identify smokers and at-risk drinkers. The instrument is available in English and Spanish.

A workshop curriculum was developed for a 3.5 hour training of primary care clinicians on the implementation of a screening and brief counseling intervention for smokers and at-risk drinkers. The curriculum includes materials about:

• health risks associated with tobacco and heavy drinking
• key ingredients of effective screening and brief counseling
• role play activities
• strategies for successful implementation

For Download:
Health & Lifestyle Screen - English (.DOC / Word 144 Kb)
Health & Lifestyle Screen - Spanish (.DOC / Word 148 Kb)

Brief Intervention Guide - Risky Drinking - English (.DOC / Word 120 Kb)
Brief Intervention Guide - Risky Smoking - English (.DOC / Word 76 Kb)

Feedback Report for Patients - Risky Drinking & Smoking - English
(.DOC / Word 140 Kb)

Feedback Report for Patients - Risky Drinking - Spanish (.DOC / Word 100 Kb)
Feedback Report for Patients - Risky Smoking - Spanish (.DOC / Word 64 Kb)

Curriculum for Implementing Screening and Brief Intervention Services for Smokers and at-risk Drinkers in Primary Care Settings ( .PPT / PowerPoint 13.1 Mb)

Pediatric Pittsburgh Network (PitNet)
Contact: Ellen Wald, MD
Ellen.Wald@chp.edu

*Educational Handouts for Parents and Assessment Instruments of Knowledge about Pediatric Overweight
An educational handout was developed as a guide for parents to help kids increase healthy eating and physical activity. The 12-page handout contains information about weight measurement including BMI, healthy foods and making good food choices, portion size, recommendations for physical activity, tips for adopting a healthy lifestyle, meal plans, and online resources. The Habit Book contains goal setting materials, food and activity logs.

Three instruments were developed to assess knowledge of overweight and its treatment from providers (27 items), nurses or health educators (40 items), and parents (16 items). An additional instrument was developed to assess parents’ perceptions of overweight in their children and accompanying guidelines for clinicians’ review of parent perceptions.

* Please contact Ellen Wald (Ellen.Wald@chp.edu) or Lin Ewing (EwingLJ@upmc.edu) to obtain a copy of these educational and assessment tools

Pediatric Practice Research Group (PPRG)
Contact: Helen Binns, MD, MPH
hbinns@northwestern.edu


Online Resources on Child Nutrition and Physical Activity for Primary Care Providers and Parents: www.childrensmrc.org/pprg/resources/

This website contains educational resources for primary care providers that include:

• Health for a Lifetime: A reference manual for primary care for the prevention and management of childhood obesity
• educational handouts for families in English and Spanish for normal weight and overweight children from 0 months to adolescence, and for underweight children 2 years and older
• male and female percent of ideal body weight (%IBW) growth charts for children 0 – 20 years. Available in black & white and in color for both metric and English units

Research Association of Practices (RAP)
Contact: Susan Flocke, PhD
susan.flocke@case.edu

ARCH Website: www.arch2healthyhabits.org
This website was designed to connect patients of primary care practices in Cleveland, OH to resources for living a healthier lifestyle including:

• community programs in Cuyahoga County for weight loss, exercise, diet and nutrition, and quitting smoking
• information about diet, exercise, smoking, & your health
• guides and action plans to help change health behaviors
• healthy behavior tips, quizzes, and calculators
• website links where you can talk to others trying to change health behaviors

Virginia Practice Support and Research Network (VaPSRN)
Contact: Scott Strayer, MD, MPH
SMS6U@hscmail.mcc.virginia.edu

*MLIT Software Program for Handheld Computers
The Modular Lifestyle Intervention Tool (MLIT), a novel software program for handheld computers was designed to improve clinicians’ ability to provide patient-tailored counseling about smoking cessation at the point of care. The MLIT’s theoretical underpinning is the Transtheoretical Model (TTM) of health behavior change. The MLIT guides the identification of the patient’s current “stage” and assists clinicians with stage-based smoking cessation counseling. Each stage is linked to scripted motivational interviewing (MI) and stage- relevant clinical content. The tool also contains local and national resources for smoking cessation follow-up (i.e., National Cancer Institute’s smoking quitline telephone number).

• Main Screen Subject Files (Table of Contents)
  --precontemplation
  --contemplation
  --preparation
  --action
  --maintenance
  --relapse
  --motivational interviewing – DARES
  --stages of change tool
  --local and national resources
• Smoking Category
  --commonly prescribed smoking cessation drugs
  --second-line pharmacotherapy
  --smoking dependency assessment (Fagerström Questionnaire)
  

Main Screen Assessment	Stages of Change Recommendations	Stage-based Counseling Main Screen
Pharmacotherapy Main Screen	Smoking Cessation Resources