2013 PROJECT ACCESS HEALTH OUTCOMES SURVEY RESULTS
Conclusion
In 2013, Project Access patients who exited Project Access and who participated in
both a pre- and post-survey by telephone, showed a marked improvement in selfreported health status. An internally developed health outcomes survey was used.
Analysis indicated both statistically significant and clinically substantive results.
Notes
Scores for the survey instrument range from 5 (best possible self-reported health) to 25
(worst possible self-reported health). There is a range of 21 possible scores in this
survey. Negative difference scores represent improvement and positive
difference scores represent a deterioration of perceived health. The 2013 Project
Access benchmark for the health outcome surveys is a 10% improvement (i.e.,
reduction or negative difference) in total population mean scores for 90% of patients.
Methodology
Health outcomes surveys were conducted by telephone with Project Access patients on
a voluntary basis. Post-test surveys were administered to patients who exited Project
Access and who had participated in a pre-test survey conducted shortly after their
enrollment in the program.
Paired scores were evaluated for all 207 patients who completed a pre-test in 2011,
2012 or 2013 and a post-test in 2013. Difference scores were calculated by subtracting
the pre-test score from the post-test score. Pre- and post-test scores were analyzed
using a paired t-test to compare means.
Results
A comparison of means showed an improvement of 2.00 points (actually -2.00, which
indicates improved reported health status) for the total population upon post-test. T-test
results indicate that the results are statistically significant (p<.001). A total population
mean reduction of 2.00 points may also be considered clinically substantive, given
that a number of Project Access patients have degenerative or chronic conditions,
where physical and emotional health status may remain the same or decline even with
access to high-quality treatment.
As compared to the total population mean pre-test score of 13.90, the mean post-test
score is reduced to 11.90. A reduction of 2.00 points is a 14% improvement in the
mean population scores (13.90 – 11.90 = 2.00/13.90 = 14%). As noted above, a 10%
reduction is the benchmark for the 2013 Project Access health outcome measure. The
mode (most frequent) pre-test score was 9, while the most frequent post-test score was
6, which is quite close to the best possible score of 5. See scatterplots on p. 3.
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125 out of 207 patients (60%) reported improved health status, with improved scores
ranging from -1 to -18 points. This group of patients had higher (worse) average pretest scores (14.95), but had a larger average improvement of -4.79 points to a post-test
average of 10.16 points. This represents a 32% (4.79/14.95) improvement for this
group only.
Employment status
Change in employment status was also measured. Patients were asked at pre- and
post-test whether they were employed. No benchmark for these results was set in
2013.
Important note: Unemployed people may be more likely to take daytime telephone
surveys, so these results may be overrepresented by those who were unemployed at
the time of the survey. Because of this possible problem, Project Access will measure
employment status with questionnaire items from a mailed patient survey in 2014.
Employment status - results
48% (100) of respondents were employed at both pre- and post-test.
33% (68) were unemployed at both pre- and post-test.
11% (22) became unemployed.
8% (17) became employed.
Social/emotional functioning
The health outcomes survey has one item that inquires about limitations of daily
functioning due to emotional or mental health. This is a question with three possible
responses, with a score of “1” representing “not” limited functioning and “5” representing
“very limited” functioning.
56% (116) of respondents had unchanged functioning at post-test, while 29% (61) had
improved functioning and 14% (28) had decreased functioning. The mean score
improved by 15% from 2.50 to 2.12 (roughly halfway between “not limited” and
“somewhat limited”). The change in mean scores is significant at p<.001.
The median (or halfway point, with half the answers above and half the answers below)
and mode (most frequent response) changed from pre-test to post-test. The median
and mode scores for the pre-test on this item were 3 (somewhat limited), while the
median and mode scores for the post-test on this item were 1 (not limited at all).
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SCATTERPLOTS
Total scores, items 1 – 5, pre-test (Note: 5 = best possible score; 25 = worst possible score)
30
25
20
15
Series1
10
5
0
0
100
200
300
400
500
Total scores, items 1 – 5, post-test (Note: 5 = best possible score; 25 = worst possible score)
30
25
20
15
Series1
10
5
0
0
100
200
300
400
500
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SCATTERPLOTS
Scores for item 5 only, pre-test (Note: 1 = best possible score; 5 = worst possible score)
(Single item that measures daily functioning limitations due to emotional or mental health)
6
5
4
3
Series1
2
1
0
0
100
200
300
400
500
Scores for item 5 only, pre-test (Note: 1 = best possible score; 5 = worst possible score)
6
5
4
3
Series1
2
1
0
0
100
200
300
400
500
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June 2014