Health appraisal and the Adverse Childhood Experiences Study: National implications for health care, cost, and utilization

This paper describes a local system in the Kaiser Permanente Medical Care Program's Department of Preventive Medicine in San Diego, CA, USA, which has substantially reduced the cost of certain basic medical services. As part of the program, patients undergo a comprehensive, two-part medical examination (or health appraisal) involving a detailed medical history, various medical and laboratory tests (eg lung function testing, audiology, visual acuity, chest radiograph and/or mammography), and physical examination. Within the program, lung function was measured using a Vitalograph spirometer.