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The University Health System (UHS) in San Antonio, Texas, uses all of the U.S. Preventive Services Task Force (USPSTF) recommendations and has integrated an ´óÏóAPPpreventive services tool, the Health Risk Profile, into its primary care clinics. The tool has been adapted for patients, and the UHS updates this as new USPSTF recommendations are released.

"We're very excited that we've created a system whereby we can easily learn which patients need which specific preventive services and can provide those services in a cost-effective, evidence-based way," says Priti Mody-Bailey, MD, Medical Director for two of the UHS clinics and HMO, and originator of the prevention program. "We could not have achieved this without support from our senior executive leadership, which has championed prevention and provided the resources. Moreover, we're very grateful for AHRQ's tools and the Task Force recommendations, which have been the basis of this program."

UHS installed computers kiosks in waiting rooms where patients complete their own Health Risk Profiles when they enroll in Carelink, UHS's financial assistance program. Patients answer the questionnaire using a simple yes/no touch screen. All patients are asked questions about several key USPSTF areas that, for this population, were determined to have the most impact on morbidity and mortality: cancer screening, BMI, tobacco cessation, and adult immunizations.

After patients complete Health Risk Profiles, users and health care providers receive Individual Risk Profile Reports that include resources and recommendations aimed at risk reduction and promoting healthy behaviors. In order to address the predominantly low reading level and largely Hispanic/Latino membership, UHS adapted the tool to a sixth-grade reading level and translated it into Spanish.

Results have been useful to both staff and members, as reflected in the improved immunization rates and inclusion of tobacco counseling. Because of systematic use of the USPSTF's evidence-based recommendations and greater involvement by UHS members in decisions about their own health care, both patients and staff are enthused about the program. Once the adoption of electronic medical records is complete, UHS will more easily be able to obtain all necessary risk profile information on all patients. UHS is also developing an audio version to help address the health literacy gap.

The University Health System is the county hospital district for Bexar County, Texas. UHS includes several outpatient clinics, University Hospital, an HMO, the Carelink Program, and a Primary Care Physician Group, and is a partner with the University of Texas Health Science Center at San Antonio. Carelink provides health care to nearly 70,000 individuals in San Antonio.