The document summarizes a clinical trial that evaluated the impact of incorporating the Pet Wellness Report (PWR) health risk assessment into routine wellness exams. The trial found that combining PWR questionnaires, exams, and diagnostic testing identified new medical conditions in 36% of dogs and 28% of cats. It also found increased revenue, improved owner compliance with recommendations, and high owner and veterinarian satisfaction with the enhanced exam compared to conventional exams. The study demonstrates that more comprehensive health assessments provide medical, financial and perceptual benefits for pets, owners and practices.

1. OVERVIEW
March 2015
• The Pet Wellness Report (PWR) is a veterinary Health Risk
Assessment (HRA) that was developed for use in a wellness
exam setting for dogs and cats.
• In December 2014, the American American
Animal Hospital Association (AAHA) selected
the PWR as AAHA’s exclusive Preferred Business
Provider for Health Risk Assessments in veteri-
nary medicine. AAHA accredited hospitals are traditionally
at the forefront of advancing new approaches to medical
care for companion animals and the recommendation
emphasizes the importance of enhancing the pet owner
perception of value for the veterinary wellness exam.
• The PWR features a client-completed, online questionnaire
used to gather pet lifestyle and health observations which
can optionally be combined with basic or comprehensive
diagnostic screening (Table 1). These components are used
to generate a pet-specific health risk summary report for
the pet owner. Client collaboration through the HRA process
makes this PWR-enhanced exam a more engaging
interaction than a conventional wellness visit.
• Incorporating the Pet Wellness Report into the wellness
visit, the principal tool of preventive veterinary health care,
Robert Lavan, MS, DVM, MPVM, DACVPM, Zoetis Inc.
Joyce A. Login, DVM, Zoetis Inc.
Dennis J. Chmiel Jr., DVM, MBA, Zoetis Inc.
A HEALTH RISK ASSESSMENT (HRA)
CLINICAL TRIAL:
Medical, Perceptual, and Financial Impacts
of Combining the Pet Wellness Report®
with Canine & Feline Wellness Exams
provides enhanced medical, perceptual, and financial
benefits to this routine companion animal service.
• This eight-month prospective, observational study was
performed, starting in April 2013, at 19 primary care veteri-
nary practices. Each hospital was asked to administer the
Pet Wellness Report as a part of a wellness visit to 24
canine and 6 feline patients with a total enrollment of 449
dogs and 114 cats.
• Study outcomes that were measured included:
1. Identification of new medical diagnoses
2.The degree of pet owner compliance with
veterinarian recommendations
3.Pet owner and veterinary perceptions of
satisfaction following the inclusion of the PWR
4.Economic impact to the practice
Medical Impact of the PWR
• After the PWR-enhanced exam was performed, veterinarians
identified newly diagnosed medical conditions in 36%
(162/449) of dogs and 28% (32/114) of cats. These pets were
considered clinically healthy at their last veterinary visit, less
than 90 days prior. Animals that were not found healthy at
the last veterinary visit were excluded from the study.

2. 2
acknowledge that the pet owner is the lifestyle
expert of their pet. Currently, there are few
communication tools that allow veterinary
teams to quickly quantify the owner’s at-home
observations. In a short examination period,
time spent obtaining a history can be limited,
and important clues to the pet’s well-being may
be missed. The HRA bolsters the veterinary
provider’s understanding of patient lifestyle and
pet owner observations of their pet (i.e.,
through the HRA questionnaire) as well as
underlying immune and metabolic functions
(i.e., when incorporating optional wellness
diagnostics). Veterinarians can then assimilate
information from each layer of the evaluation
(i.e., HRA questionnaire, history, physical exam,
and wellness diagnostics) to more quickly arrive
at diagnoses and offer more patient-specific
recommendations for maintaining or improving
that pet’s quality of life (Table 1).
Unfortunately, many pet owners (especially cat
owners) use veterinary services sporadically for
C
ompanion animal medicine may need to
shift away from the traditional reactive,
illness-focused model of veterinary health
care towards a more sustainable, wellness-
centered approach (Chmiel et al, 2014). This
moves veterinarians primarily from problem
solving to problem preventing, and encourages
pet owners to establish healthier lifestyle habits
for their pets and engage with their veterinarian
more frequently and meaningfully. The industry
shift emphasizes prevention, early detection of
disease, and timely treatment intervention (i.e.,
the opposite of “wait and see”). This more
proactive approach to prevention, detection,
and treatment, extended throughout the pet’s
lifetime is the basis for the Zoetis Lifelong Care
Initiative (Ackerman et al, 2013). Lifelong Care
offers a thoughtful pathway to pet, pet owner,
and practice wellness. The Health Risk Assess-
ment (HRA) process effectively promotes this
Lifelong Care approach.
While veterinarians are experts in the medical
care of companion animals, we should
INTRODUCTION
• Pet owner compliance was measured as the frequency that
a pet owner acted on a veterinarian recommendation during
the two-week period following the PWR. In this study,
compliance with treatment recommendations for new
diagnoses averaged 48% but was widely variable between
practices, ranging from 14% to 100%.
Financial Impact of the PWR
• Hospital records were examined two weeks after the final
PWR was completed by the last pet owner. Veterinary
practices averaged $619 in total additional revenue from
products or services related to treating the new medical
diagnoses from the pets that had participated in the PWR.
• Average per-patient practice revenue derived from treating
medical diagnoses (n = 96) within the two-week post-PWR
study window was $126.80 for dogs and $124.29 for cats.
Veterinarian and Client Perception of the PWR
• In post-clinical trial surveys of participating veterinarians (n
= 53), approximately 60% said that the PWR-enhanced
exam provided superior value to the pet, veterinarian, and
the practice compared to a conventional wellness exam, and
more than 80% of these responding veterinarians said it
provided superior value to the client versus a conventional
wellness exam.
• More than half of veterinarians in post-trial surveys said that
the PWR-enhanced wellness exam was more likely to
improve client satisfaction, generate new clinic revenue, and
detect subclinical disease compared to a conventional
routine visit.
• 90% of pet owners (n = 288) who completed a perception
of care survey after the PWR-enhanced exam said they
were satisfied or very satisfied with the PWR experience.
More than 70% said it provided an improved quality of care
when compared to a conventional exam, and more than
80% said they would recommend the PWR to a friend.
Summary
• The AAHA-recommended Pet Wellness Report (PWR) is the
first broadly available, standardized HRA service process for
companion animal veterinary medicine. The HRA is not
intended to be a stand-alone diagnostic tool; rather, it is
meant to enhance dog and cat wellness evaluations.
• The clinical trial confirmed that combining the PWR Health
Risk Assessment process with a routine wellness exam can
be an important contributor to the clinical and economic
success of the practice and a positive factor in veterinary
and pet owner perception of value.
• Information on the Pet Wellness Report can be found at
www.petwellnessreport.com and by searching Health Risk
Assessment, Lifelong Care supplements, or Preferred
Business Provider at www.aaha.org.
The Zoetis Lifelong
Care Initiative is the
extension of a
proactive health care
approach throughout
the pet’s lifetime,
providing a thoughtful
pathway to pet, pet
owner, and practice
wellness. The Health
Risk Assessment (HRA)
process effectively
promotes this Lifelong
Care approach.

3. 3
acute care or vaccinations (Volk et al, 2011).
Veterinary practices that emphasize preventive
health care need to persuade clients to become
regular consumers of veterinary care throughout
their pets’ lifetime rather than as-needed users
for purposes of treating disease or injury
(Cavanaugh, 2013). The PWR can enhance the
wellness visit, the principal tool of preventive
health care, beyond what is normally offered in
companion animal practice today. By actively
engaging the client in the wellness visit through
the completion of the Health Risk Assessment,
the PWR process provides an opportunity for
client contribution and education related to
their pet’s lifestyle and for prompting additional
dialogue between veterinarian and pet owner.
Pet Wellness Report questionnaire responses
help identify risks in several areas of pet health
or lifestyle, including cancer, heart disease,
dental disease, nutrition, and safety. The PWR
technology platform can combine these
responses with the results of basic or
comprehensive wellness laboratory screening
when included as part of the HRA process.
Zoetis 2013 market research (n = 151) shows that
only a small percentage (12%) of veterinarians
were recommending comprehensive laboratory
blood screening (i.e., CBC, clinical chemistry,
urinalysis, T4, +/- blood or fecal parasite
screening, +/- FeLV & FIV) during routine
wellness visits.
The questionnaire findings and laboratory
screening results are used to prepare a patient-
specific Pet Wellness Report (PWR) that is
given to the client. The PWR allows the
attending veterinarian to digitally incorporate
personalized notations which communicate
additional interpretation and recommendations
related to the patient’s health. The pet owner
can continue to access and refer to these PWR
results and recommendations later at
www.petwellnessreport.com, improving the
clarity of communication from the PWR-
enhanced wellness visit. Using a collaborative
approach involving the client and veterinarian, a
PWR-enhanced exam becomes a more robust
wellness service than the conventional
preventive care visit.
Information gathering from the pet owner
during the conventional preventive care visit is
often the more cursory, on-the-spot patient
history, and diagnostics are usually limited to
basic parasite screening (41% of annual wellness
visits according to data on file, Pet Wellness
Report Pricing Solutions Study, 2013 Zoetis Inc.).
Providing the client with a personalized, easy to
read report summarizing the additional layers of
HRA evaluation increases the value of
the exam experience for the pet
owner, enhances communication with
the veterinarian and may improve
compliance with treatment
recommendations. Survey data shows
that nearly 80% of pet owners want
written as well as verbal post-exam
instructions (AAHA, 2003), and that
written information is strongly
correlated with increased adherence
to treatment instructions (AAHA, 2009).
Data demonstrate that pet owners remain
willing to spend money on their pets. However,
Conventional Wellness Exam
• Patient history
• Physical exam
• ±Basic parasite screening
Pet Wellness Report (PWR)
Enhanced Wellness Exam
• Health Risk Assessment (HRA) questionnaire
• Patient history
• Physical exam
• ±Comprehensive laboratory screening
- Hematologic panel
- 25-Analyte metabolic panel
- Urinalysis
- T4 assay
• ±Parasite screening
• Personalized risk summary report for client
Table 1.
Comparing the Conventional
Wellness Exam with the
Pet Wellness Report Enhanced
Wellness Exam
The pet owner can continue to
access and refer to these results
and recommendations later at
www.petwellnessreport.com,
improving the clarity of
communication from the annual
wellness visit.

4. 4
there is a gross disparity between pet owner
spending on pet products compared to spend-
ing on veterinary care. Since 1994, domestic pet
industry sales have steadily climbed, with the
sales of animal-oriented products and services
seemingly immune to the recent U.S. economic
recession (APPA Pet Industry Market Size &
Ownership Statistics, U.S. Pet Industry Spending
Figures & Future Outlook, 2014). Despite this
growth, there has been a prolonged trend of
declining veterinary-patient visits and a
declining number of active veterinary clients
beginning before the recent economic recession
(Volk et al, 2011). Regular wellness visits have
never been more important in companion
animal medicine.
Attention to these market changes is finally
increasing. New canine and feline preventive
health care guidelines (AAHA-AVMA Task Force,
2011) were developed to be used during regular
wellness exams, which has increased the
likelihood of recognizing disease and other
health risks at an early stage. AAHA has
developed Pet, Canine, and Feline Lifestyle
Assessment forms (AAHA Lifestyle Assessment
Forms, 2014) to focus veterinary health care
toward the HRA concept through the identifica-
tion of a variety of pet lifestyle issues. AAHA
also supports Partners for Healthy Pets (PHP),
which was formed by numerous veterinary
industry stakeholders to provide guidance to
veterinarians on how to increase preventive care
visits for pets (www.partnersforhealthypets.
org). The goal of PHP is to ensure that pets can
enjoy a longer, healthier life with their pet
owners through the prevention and early
detection of diseases.
The Health Risk Assessment clinical trial
described in this report evaluated the impact of
the PWR from several standpoints:
• Medical – ability to recognize previously
undiagnosed morbidities and empower client
compliance with recommendations
• Perception – the value of the PWR-enhanced
exam compared to the conventional wellness
exam as perceived by participating
veterinarians and pet owners
• Financial – new revenue resulting from treat-
ing new health issues (two weeks post-PWR)
It is proposed that this more complete Health
Risk Assessment process will better identify
modifiable health risks and reveal subclinical
medical conditions not uncovered in the typical
wellness exam process (Goetzel et al, 2011; Knesl
et al, 2013; Lavan et al, 2014). The findings from
this more proactive approach to wellness care
are proposed to provide additional revenue-
generating opportunities for the practice.
Further, the pet owner–veterinary team
collaboration and communication arising from
this enhanced evaluation is expected to improve
pet owner perception of value for the veterinary
wellness exam.
INTRODUCTION
The American Animal
Hospital Association
(AAHA) has recom-
mended the Pet
Wellness Report by
endorsing it as the
only AAHA Preferred
Business Provider in
the Health Risk
Assessment category.

5. MATERIALS and
METHODS
5
Study Design
Nineteen companion animal practices in New
Jersey, New York, and Ohio participated in
this prospective, observational clinical trial
conducted from April to November, 2013. Each
practice invited approximately 30 clients to
present a canine or feline pet for a wellness
exam augmented by the Pet Wellness Report
(PWR), with a goal of enrolling 24 dogs and 6
cats per practice. In order to compare the
annual wellness visit with the PWR-enhanced
visit, all invited patients had received the routine
annual wellness exam at the same practice 60
to 90 days prior to their enrollment in the study.
The maximum 90-day interval between the
conventional wellness exam and the Pet
Wellness Report enhanced exam was expected
to be short enough so pet owners could
compare the two wellness visit approaches with
minimal recall bias. Only patients that were
found to be clinically healthy at the earlier exam
were included in the trial. This inclusion criterion
was to select the healthiest of the healthy
animals. Any patients found to have medical
problems at the conventional wellness visit were
excluded from this study. This inclusion criterion
may have produced a selection bias by reducing
the number of new health findings that could
have been detected from the PWR-enhanced
wellness visit.
Use of The Pet Wellness Report
The PWR can be completed before or after the
wellness visit, and with or without wellness
diagnostics. The PWR-enhanced exam process
in this clinical trial combined an online HRA
questionnaire completed by the pet owner with
comprehensive laboratory screening. Pet owners
completed the HRA questionnaire after the
wellness visit and diagnostic sample collection.
The laboratory analysis consisted of a complete
blood count (CBC), 25-analyte metabolic panel,
heartworm antigen, urinalysis, and total
thyroxine (T4) assay, with tick-borne parasite
screening as a discretionary option for dogs
depending on the veterinarian’s recommenda-
tion (Table 1). Pet owner visibility to the PWR
results occurred approximately 48 hours after
the wellness examination and could include
personalized comments and/or recommenda-
tions from the veterinarian in the report. This
online report was accessed by the pet owner
and veterinarian through a password protected
website (www.petwellnessreport.com). Pet
owners were not charged for the PWR HRA
questionnaire, the associated blood and urine
laboratory screening, or the personalized PWR
patient report.
All clients were asked to complete a post-PWR
perception of care survey, which included
questions comparing the initial conventional
wellness exam and the subsequent PWR-
enhanced wellness exam. At the conclusion of
the trial, participating veterinarians completed
their own perception of care survey comparing
the conventional wellness exam with their
experiences participating in the PWR process
with their clients.
Data Mining the Medical Records
Medical records were examined to identify the
number and type of new (previously undiag-
nosed) health conditions identified in the PWR-
enhanced exams. The case veterinarian had to
specifically identify concerns, risks or medical
findings in the medical record for their inclusion
as new health conditions. New medical findings
seen by the study administrators but not
identified within the medical record by the case
veterinarian were not included as tabulated
findings.
The total revenue generated was assessed from
the charges recorded in the medical record that
were incurred when pet owners agreed to
veterinary recommendations. Treatment
compliance was defined as a revenue-
generating procedure agreed to by the client in
response to a recommendation made by the
attending veterinarian for any newly diagnosed
condition(s). Charges associated with these
treatments, services or product sales performed
within two weeks of the PWR-enhanced exams
were captured for analysis. Charges that
occurred after the post-PWR two-week window
were not researched.
Results
The patient population enrolled in the study was
well distributed among age groupings (i.e., 1-4
years, 4-8 years and >8 years for dogs; 1-10
years and >10 years for cats), providing a good
representation of juvenile, adult, and senior

6. 6
MATERIALS and
METHODS dogs and cats. None of the three canine age
groups had a population that was less than 30%
of the total, and the number of cats in the two
feline age groups were closely divided in
number. Compliance with the study protocol
was very good, however 14 dogs (3%) and 7 cats
(6%) received lab work without completing the
PWR Health Risk Assessment questionnaire. A
total of 473 dogs and 123 cats participated in
the study with full data sets gathered from 449
dogs and 114 cats. Revenue data from resulting
diagnostic or therapeutic interventions were
obtained for 78 dogs and 15 cats. A post-trial
perception of care survey was completed by 288
(51.2%) of participating clients and 53 attending
veterinarians.
Medical Impact of PWR-Enhanced
Wellness Exam
The rate and type of new medical diagnoses for
dogs and cats enrolled in the trial are shown in
Table 2. Dogs had an overall rate of new
diagnoses of 36% (162/449) across 19 clinics
that enrolled 21-26 dogs. The number of new
health findings ranged from 10% (2/21) to 73%
(16/22) across study sites. In some cases, dogs
had more than one new morbidity diagnosed
(i.e., 194 new health findings for 162 dogs),
whereas no cat had more than one new
diagnosis per individual. New diagnoses were
more commonly found as dogs aged, with those
≥8 years having a 44% incidence of new health
findings (69/156) versus 32% (51/158) in the 4-8
year age group and 31% (42/135) in the 1-4 year
group. An assortment of new morbidities were
identified in canine patients that had been
considered clinically normal at the wellness
exam performed within the previous 60-90
days. Hypothyroidism (either untreated or
under-medicated), proteinuria, urinary tract
infections, and dental conditions were among
the most common diagnoses in all three age
groups. A positive Lyme test was the most
frequent new diagnosis in dogs in the 1-4 year
Medical Impact:
The PWR-enhanced
exam revealed
new (previously
undiagnosed)
medical findings in
36% (162/449) of
dogs and 28%
(32/114) of cats.
Table 2.
New medical diagnoses identified for canine and feline patients
with the Pet Wellness Report Enhanced Wellness Exam
Incidence of
new medical
Age block diagnoses* Most common new diagnosis (n)
Canine patients (n = 449)
1.0-4.0 yrs 31% (42/135) Lyme positive (9); crystalluria (7);
proteinuria (5); UTI (4); broken or retained
teeth (4); hypothyroidism† (4); all others (≤3)
4.1-8.0 yrs 32% (51/158) hypothyroidism† (7); proteinuria (7); UTI (7);
Lyme positive (6); dental disease (4);
all others (≤4)
≥8.1 yrs 44% (69/156) hypothyroidism† (14); UTI (10); proteinuria (9);
dental disease (10); renal disease (7);
all others (≤6)
All ages 36% (162/449)
Feline patients (n = 114)
1.0-10.0 yrs 26% (16/61) proteinuria (3); eosinophilia (3); all others (≤2)
>10.1 yrs 30% (16/53) renal disease (4); hyperthyroidism† ±
hypertension (3); all others (≤ 2)
All ages 28% (32/114)
*Incidence refers to the number of dogs that had new (one or more) medical diagnoses.
†Either untreated or under-medicated. UTI = urinary tract infection.

7. 7
group and the fourth most common new health
finding in the 4-8 year old group, behind
hypothyroidism, proteinuria and UTI.
Overall, cats had a rate of new diagnoses of 28%
(32/114) across 19 clinics that enrolled 4-7 cats.
The number of new health findings in cats
ranged from 0% (0/6) to 66% (4/6) across
study sites. The rate of a new diagnosis in each
age block averaged 26% (16/61) in the 1-10 year
block and 30% (16/53) in the >10 year groups,
respectively. No single morbidity predominated
in either feline age group (Table 2). It seems
likely that the incidence of new health findings
for dogs and cats would continue to increase as
the time period from the last normal wellness
checkup was extended beyond the 60-90 day
interval in this study.
PWR-Enhanced Exam Treatment
Compliance
In most cases, when new medical diagnoses
occurred, the attending veterinarian made a
treatment recommendation. Treatment
compliance was measured as the percentage of
pet owners that accepted one or more of the
veterinary recommendations and agreed to pay
for a recommended service and/or product
within the two-week post-PWR service process.
Between clinics, pet owner compliance with
these recommendations varied between 14%
and 100%. Combined treatment compliance for
all 19 practices averaged 48% (78/161) in canine
cases and 47% (15/32) in feline cases.
Financial Impact of PWR-Enhanced
Wellness Exam
Within the immediate two-week post-PWR
period, total revenue derived from the services
or products associated with newly diagnosed
morbidities for the 19 clinics averaged $619.00
per clinic. The total amount spent to treat new
findings by all pet owners in the PWR clinical
trial at a given clinic ranged from $58.50 to
$2,101.93. Average revenue for all patients with a
new medical diagnosis, whether treated or not
(n = 193), was $60.91. Average per-patient
revenue for new health findings that were
treated (n = 96) was $126.80 for dogs and
$124.29 for cats.
In many cases, the two-week study interval
between the PWR visit and medical record data
mining was not enough time for the pet owner
to be contacted by the clinic, for the pet owner
to respond to a clinic request for a discussion,
or for the clinic to schedule and execute the
recommended treatment. This time limitation
cut short our ability to capture the full economic
benefit that resulted from the PWR experience,
thus probably resulting in an underestimation of
the economic benefit seen in the day-to-day use
of the PWR in clinical practice.
Figure 1 – Veterinarian responses on their experience with the PWR
Veterinary Perception of the PWR-Enhanced Wellness Exam
Ability to improve owner compliance
Ability to improve owner satisfaction
Ability to detect subclinical disease
Ability to generate new clinic revenue
0% 20%
Not Likely Less Likely Same More Likely Much More Likely
40% 60% 80% 100%
49.1%
34.0%
35.8%
34.8% 54.7% 7.5%
47%
60%
59%
62%
More Likely + Much More Likely
52.8% 5.7%
56.6% 3.8%
41.5% 5.7%

8. 8
MATERIALS and
METHODS
Veterinarian Perception of
PWR-Enhanced Wellness Exam
Veterinarians were asked eight questions about
their PWR experience upon completing all 30
PWR-enhanced office visits (Figures 1 and 2). At
the time of their responses, the veterinarians (n
= 53) were unaware of the aggregated medical,
financial and pet owner perception findings for
the clinical trial. More than half (58.5%) of the
responding veterinarians believed the PWR was
more likely or much more likely to generate new
clinic revenue. More than 60 percent believed
Figure 2 – Veterinarian responses on the value of the PWR
Veterinary Perception of the PWR-Enhanced Wellness Exam
the PWR was more likely or much more likely to
improve client satisfaction (60.4%) and detect
subclinical disease (62.2%). Almost half (47.2%)
believed the PWR improved pet owner
compliance.
When asked about the value of the PWR, more
than half of the veterinarians surveyed said that
the PWR-enhanced exam provided superior
value compared to the conventional wellness
exam for all stakeholders involved: pet (62.3%),
pet owner (80.8%), veterinarian (57.7%), and
clinic/hospital (58.5%).
Pet Owner Perception of the PWR-Enhanced Wellness Exam
Figure 3 – Pet owner responses on their experience with the PWR
34.0%
15.4%
32.7% 42.3% 15.4%
35.8% 47.2% 11.3%
73.1% 7.7%
62%
81%
58%
59%
45.3% 17.0%Value to the pet
Value to the pet owner
Value to you (the veterinarian)
Value to the clinic/hospital
Not Valuable Less Valuable Same More Valuable Very Valuable
More Valuable + Very Valuable
0% 20% 40% 60% 80% 100%
Much Less Less Same More Much More
71%
71%
82%
83%
77%
More + Much More
Feels engaged with pet’s care
Improved quality of care
More likely to identify health problems
Provides a more thorough evaluation
Provided value
to the pet’s health
0% 20% 40% 60% 80% 100%
28.0% 45.1% 26.2%
27.7% 40.4% 30.9%
16.9% 45.4% 36.6%
16.2% 45.5% 37.3%
21.9% 46.3% 31.1%
Clients agreed or
strongly agreed that,
because of the PWR,
they felt better
informed about their
pet (86.3%) and better
able to discuss health
care with their
veterinarian (75.7%).

9. 9
Figure 4 – Pet owner responses on the value of the PWR
Client Perception of the
PWR-Enhanced Wellness Exam
The pet owners received an online link to a
short perception of care survey after receiving
access to their completed Pet Wellness Report.
The survey was completed by 51% (n = 288/
570) of pet owners (Figures 3, 4, 5 and 6).
Compared to the conventional wellness exam
experience 60-90 days prior, the PWR-
enhanced exam provided more or much more
value to the pet’s health according to 77.4% of
clients surveyed. Clients reported that the PWR
was more or much more valuable in providing
improved quality of care (71.3%), identifying
health problems (81.6%), and in providing a
more thorough evaluation (82.8%). Clients
agreed or strongly agreed that, because of the
PWR, they felt better informed about their pet
(86.3%) and better able to discuss health care
with their veterinarian (75.7%). Clients felt more
or much more engaged in their pet's health care
(71.3%) and 90.5% of pet owners indicated that
they were satisfied or very satisfied with the
PWR experience (Figure 3 and 5). Finally, the
large majority of pet owners (81.6%) would
recommend PWR to a friend (Figure 6).
The fact that pet owners were not charged for
the PWR questionnaire, the repeat history and
physical exam, and associated lab work may
have influenced the pet owner assessment of
value (Figure 3: “more valuable to my pet’s
health”). However, responses to other questions
on the pet owner perception of care survey are
expected to be less affected (Figures 3 and 4:
“more thorough exam”, “feel better informed”).
Pet Owner Perception of the PWR-Enhanced Wellness Exam
Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree
76%
86%
Better able to discuss
healthcare with veterinarian
Feels better informed
0% 20% 40% 60% 80% 100%
21.5% 44.7% 31.0%
11.6% 52.5% 33.8%
Agree + Strongly Agree
Pet Owner Perception of Care Survey
“In completing the first (“standard”) office visit with the Pet Wellness Report
office visit (second visit), please indicate your level of satisfaction
with the Pet Wellness Report.”
“I would recommend the Pet Wellness Report to a friend.”
0
20
40
60
80
100
160
120
140
2.1%
0.0%
7.4%
38.0%
52.5%
Count
Dissatisfied Neutral Satisfied Very
Satisfied
Very
Dissatisfied
Figure 5 – Pet owner satisfaction with the PWR
90%of pet owners
indicate that they
were satisfied or very
satisfied with the
Pet Wellness
Report experience
(n=288)
Pet Owner Perception of Care Survey
Figure 6 – Pet owner satisfaction with the PWR
82%of pet owners
indicated that they
agree or strongly agree
with the statement
after completing the
PWR experience
(n=288)
0
20
40
60
80
100
160
120
140
2.1%0.4%
15.8%
49.6%
32.0%
Count
Disagree Neither
Agree nor
Disagree
Agree Strongly
Agree
Strongly
Disagree
The PWR-enhanced
exam revealed new
(previously undiag-
nosed) medical
findings in 36%
(162/449) of dogs and
28% (32/114) of cats.

10. DISCUSSION
10
The high incidence of new medical diagnoses
arising from the PWR-enhanced exam is note-
worthy because all canine and feline patients
had received a clean bill of health from the
same practice within the previous 60-90 days.
Nevertheless, 36% of dogs and 28% of cats had
a subsequent new morbidity diagnosed during
the PWR process (Table 2).
New health findings in this observational study
may have been the result of:
1. Newly acquired disease in the interval since
the pet was last examined
2. Existing subclinical disease at initial exam
progressing to clinical disease by PWR exam
3. History or physical exam discoveries missed
or misinterpreted at the earlier visit
4. New information obtained through the Health
Risk Assessment
a. PWR HRA questionnaire
b. PWR comprehensive wellness diagnostic
screening
Dogs in the older age groups had an incre-
mentally higher incidence of new diagnoses. For
example, dogs older than 8 years of age had a
44% incidence in new medical findings,
compared to an incidence of 31% in dogs 1-4
years of age. Multiple cases of positive Lyme
results, hypothyroidism, and abnormalities on
urinalysis and/or oral examination were
recorded. Without testing, many morbidities
may have remained subclinical (e.g., proteinuria,
crystalluria, hypothyroidism) or may have
eventually led to clinical disease. In cats, the
incidence of new diagnoses between the two
age blocks was very similar: 1-10 year (26%) and
>10 year (30%).
This study reported new health findings
identified by clinicians in the patient’s medical
record. It is important to note that nearly all of
these findings reported by participating
veterinarians were identified from the PWR
comprehensive laboratory analysis and/or
subsequent physical exam. The case veterinar-
ians in this study rarely used the medical record
to record new or potentially new health findings
identified in the HRA questionnaire. During data
collection, the study administrators could often
see pet owner comments in the PWR HRA that
suggested early warning signs for disease and
potentially modifiable lifestyle risks. For
example, 23% of cat owners noted one or more
signs of oral disease (Addendum A). This is a
perfect opportunity to discuss optimal oral
health and possibly additional dental care.
Twelve percent of cat owners noted that their
pets demonstrated stiffness or lameness at
home. Cats are less likely to show any signs of
weakness at the veterinary office visit and this
may be the only clue that the pet is developing
arthritis. Similarly, 39% of dog owners indicated
that they were late or completely missed doses
of heartworm medication. This is an education
moment to discuss heartworm disease and
review the pet owners’ purchase history of
heartworm prophylaxis medications. About 1/3
of dog owners indicated that their dog had one
or more signs of skin disease, which could be
further investigated with a skin scraping, allergy
test or fungal exam. Any such findings not
added to the patient medical record by the case
veterinarians were not included in the study’s
analytics.
To our knowledge, veterinary medical education
does not currently include training on the
utilization and interpretation of HRA question-
naires in clinical practice. Furthermore, Zoetis
did not provide any training for the veterinar-
ians in this study on how to best utilize the Pet
Wellness Report Health Risk Assessment (PWR
HRA). This unfamiliarity with the questionnaire
aspect of the Health Risk Assessment process
may have biased the study veterinarians to
emphasize the findings from wellness diag-
nostics and the subsequent physical exam, while
giving less attention to the responses in the
HRA questionnaire.
The value of an HRA questionnaire in the
patient health care evaluation process has been
well documented in human medicine (Goetzel
et al, 2011) and is now being recognized in
veterinary medicine. The veterinary health care
value has been demonstrated in two retro-
spective studies (Knesl et al, 2013; Lavan et al,
2014) utilizing the Pet Wellness Report. Both
studies provide interesting insights on the use of
a Health Risk Assessment questionnaire during
annual wellness visits for dogs and cats. Data
from routine wellness exams were analyzed for
7,827 canine cases and 1,197 feline cases at 264
Medical Impact of PWR-Enhanced
Wellness Exam

11. 11
Table 3.
A Comparison of Pet Owner Responses to Questions
in the Pet Wellness Report for Dogs and Cats.
PWR Question with YES response Dog1 Cat2
Is your pet overweight?
18% 22%
(1337/7333) (264/1197)
Does your pet have stiffness/lameness?
27% 11%
(2083/7823) (135/1197)
Does your pet have signs of oral disease?
30% 28%
(2315/7827) (331/1197)
Does your pet have contact with other 67% 34%
dogs (canine) or go outside (feline)? (329/494) (410/1197)
Do you give your pet medications 89% 33%
to prevent heartworm disease? (6939/7827) (390/1191)
primary care U.S. veterinary practices over a 5.5-
year period. In these patients the PWR HRA
questionnaire identified health concerns in 77%
of dogs and 68% of cats from several risk
assessment categories: cancer, heart disease,
dental disease, nutrition, and safety. These
potential health risks were recognized by pet
owners with pets of all ages. Lifestyle concerns
were self-reported in 42.5% of cats 0-3 years of
age, compared to 82.4% of cats 13+ years of age
(Lavan et al, 2014). In dogs 0-3 years of age,
60.7% had self-reported lifestyle concerns
compared to 93.7% in the 13+ year age group
(Knesl et al, 2013).
Data from the retrospective canine study using
the PWR (Knesl et al, 2013) demonstrated the
kinds of actionable information that veteri-
narians are being given by pet owners. For
example, 29% of dog owners self-reported that
their dogs were off schedule or had missed
heartworm preventive dosing, 27% reported
their dogs having signs of stiffness or lameness,
and 30% reported noticing warning signs of oral
disease (Table 3). Similar actionable information
was provided by cat owners in the retrospective
feline study (Lavan et al, 2014). Through the
feline HRA questionnaire, 10% of cat owners
reported their cat having changes in litter box
habits, 28% noticed warning signs of oral
disease, and 27% noticed hairballs or chronic
vomiting. Table 3 highlights examples of HRA
questionnaire findings from these retrospective
studies.
The value of the HRA questionnaire stems from
the important lifestyle and observational
information relevant to the health of the pet and
family. The findings from both retrospective
studies suggest that all pets can benefit from
the additional health evaluation provided by the
PWR HRA questionnaire, regardless of their age.
The HRA questionnaire offers many
opportunities to discover modifiable lifestyle
habits and create opportunities for veterinary
intervention to ensure that the healthy-looking
patient truly is and remains healthy. Additional
time and practice with the HRA process,
especially how to use the information gleaned
from the questionnaire, can potentially yield
even more medical findings, provide an even
greater financial impact to the practice, and
create even higher perceptions of value for pet
owners and veterinarians.
PWR-Enhanced Exam Treatment
Compliance
As might be expected, participating practices
reported a wide difference in the rate of client
compliance (i.e., 14% to 100%) with treatment
recommendations for newly diagnosed medical
conditions. This disparity in range may have
been influenced by pet owner–veterinarian
relationship dynamics including:
1. the client-perceived trust in the case
veterinarian
2. the client’s ability to financially afford
follow-up services, and
3. the veterinarian’s ability to explain the diag-
nosis and/or translate the importance of the
medical recommendation to the pet owner.
The measurement of compliance with veterinary
recommendations was negatively influenced by
the narrow time period within which compliance
was measured in this prospective study. The
two-week cutoff for collecting data at the end
of the trial likely resulted in understating the
average per-practice treatment compliance rate
and associated revenue. In future studies, a
period of eight weeks (or longer) might be a
more realistic interval in which to assess pet
owner compliance for veterinary recommenda-
tions resulting from newly found medical issues.
1Knesl et at, 2013 2Lavan et al, 2014

12. DISCUSSION
12
Approximately half of the clients in this PWR
clinical trial accepted veterinary recommenda-
tions for treating a newly diagnosed condition
(i.e., 48% for dogs; 47% for cats). This should be
considered a favorable response rate for
treating new morbidities compared to what has
been previously reported in other veterinary
compliance studies (AAHA, 2003; AAHA, 2009).
A large-scale survey of companion animal
practices found that compliance varies by
procedure (AAHA, 2003). Compliance tends to
be high for intermittent preventive or diagnostic
procedures such as vaccinations (87%) and
heartworm testing (83%) but much lower for
recommendations related to treating a chronic
condition such as dental care or therapeutic
diets (35% and 21%, respectively). Written
recommendations have been shown to improve
compliance (AAHA, 2009). Providing the client
with easy-to-read, patient-specific health care
content such as that created by the Pet
Wellness Report would be expected to remind
and encourage clients to consider the
veterinarian’s treatment recommendations.
Financial Impact of PWR-Enhanced
Wellness Exam
New clinic income generated by the Pet Wellness
Report represents an otherwise unrealized source
of practice revenue. This revenue was not
generated during the conventional wellness visit
that the pet had received 60-90 days prior to the
PWR-enhanced wellness exam. In applying the
PWR process to 24 dogs and 6 cats, each clinic
generated an average of $619.00 (range $59.00 -
$2,102) in treating new health findings. This is an
average of $126.80 for dogs and $124.29 for cats
that had a new medical diagnosis that was treated.
Some pet owners may have scheduled and/or paid
for follow-up diagnostic and/or treatment
procedures beyond the two-week window of the
study. The estimation of clinic revenue may be
incompletely captured by this limitation in the
follow-up.
Note that the PWR questionnaire and compre-
hensive lab work were offered complementary to
pet owners in this clinical trial. Thus, any direct
revenue potential of selling the questionnaire or
lab work is not contributing to the financial impact
for practices participating in this study. In addition,
improved utilization of questionnaire responses by
the veterinarian may identify additional health
issues of concern to the pet owner, with an
opportunity to affect patient health outcomes and
impact incremental clinic revenue.
Veterinarian Perception of Care Impact
of PWR-Enhanced Wellness Exam
In the post-trial survey, more than half of
participating veterinarians indicated that the
PWR-enhanced exam was superior to a
conventional exam service in three areas that
are central to the conduct of clinical practice:
client satisfaction, generating new revenue, and
detection of subclinical disease (Figure 1). The
favorable impact on client perception of care as
judged by veterinarians is complemented by the
pet owners belief that they were better able to
discuss health care with their veterinarian
(Figure 4). Without awareness to aggregated
trial results and pet owner responses, 47% of
veterinarians expected the PWR to improve
client compliance (Figure 1). Coincidentally this
result is consistent with the percentage of
clients who complied with their veterinarians’
treatment recommendations for newly
diagnosed conditions (i.e., 48% for dogs; 47%
for cats) in this study.
In their value assessments (Figure 2), veterinar-
ians overwhelmingly (81%) said that the PWR
provided more or much more value to their
clients compared to a conventional exam. This
outcome was especially encouraging because
the principal objective of the AAHA-AVMA
preventive health care guidelines is to make the
wellness exam the principal focus of primary
companion animal practice (AAHA-AVMA, 2011),
which now relies heavily on acute care services.
While the PWR leverages technology to
promote client centricity and preventive care, it
also includes an interactive veterinary-facing
analytics tool. The veterinary team can see
every patient’s PWR HRA questionnaire and
PWR diagnostic test results for analysis. As well,
the veterinary team can:
1. communicate with pet owners through the
analytics portion of the tool
2. group and explore patients with similar health
risks or analyte abnormalities

13. 13
3. identify widespread health care
communication gaps within the practice such
as with heartworm prevention compliance
The analytics tool can also be valuable when a
clinic develops a periodic (e.g., monthly or
seasonal) wellness program and wants to
identify patients that could benefit from a
particular medical focus such as dental care or
weight management.
Client Perception of Care Impact of
PWR-Enhanced Wellness Exam
The American Animal Hospital Association
analyzed veterinary hospital financial perform-
ance between 2011 and 2012 (Cavanaugh, 2013).
In this State of the Industry report AAHA
recognized that a select group of veterinary
hospitals experienced an exceptional level of
growth despite a depressed overall U.S.
economy. While the average growth in revenue
was 5.6% for more than 4,000 U.S. veterinary
hospitals, approximately 25% of study hospitals
exceeded 10% and some even >20% growth
(labeled as Growers). Five major factors were
determined to be critical for driving Grower
success including:
• Strengthening client relationships (i.e., client-
centricity)
• Driving regular preventive care visits
• Leveraging technology in the practice to
embed client centricity and preventive care
• Setting goals and measuring business
progress
• Communicating the value of higher standards
The single most important factor differentiating
these Growers from the Decliners (i.e., those
with negative revenue growth) was the client
relationship focus. This client-centricity was
determined to be the first key to growth.
Practices that focused on engaging clients were
more than twice as likely to be Growers as
Decliners. Believing their growth was
independent of the economy, these Grower
veterinary teams were able to communicate the
value of their services in language clients could
understand.
Grower success habits align well with an HRA
process like the PWR, which reinforces all five
drivers of success. By design, the PWR can
strengthen client relationships by engaging and
educating the pet owner through a shared
process of discovery.
In this PWR clinical trial, the clients confirmed
this enhanced perception of value with 71%
feeling more or much more engaged with their
pet’s care when the PWR was included with the
exam (Figure 3). Three out of four (76%) either
agreed or strongly agreed that they were better
able to discuss their pet’s health care with their
veterinarian (Figure 4) and 86% agreed or
strongly agreed that they felt better informed
with the Pet Wellness Report (Figure 4). These
pet owners perceived superior engagement and
educational value when the HRA process was
included in the wellness care visit.
PWR study findings demonstrated further
evidence for this enhanced value with the PWR
experience (Figures 3, 4, 5 and 6):
• 71% of pet owners felt it improved the quality
of care their pet received
• 82% felt the veterinarian was more or much
more likely to identify health problems
• 83% felt the veterinarian was able to provide a
more or much more thorough evaluation of
their pet
• 77% felt it brought value to their pet’s health,
when compared with an annual wellness visit
that did not include a health risk assessment,
comprehensive lab work and a pet-specific
written health report.
Maybe most revealing, 82% said they would
recommend the PWR to a friend (Figure 6). If
clients see more value in the wellness exam, it
may motivate them to become more regular
consumers of preventive pet health care for the
lifetime of their pet.
Practices that focused
on engaging clients
were more than twice
as likely to be Growers
as Decliners.
By design, the PWR
can strengthen client
relationships by
engaging and
educating the pet
owner through a
shared process of
discovery.

14. SUMMARY
14
Summary
The PWR can be used to engage, educate, and
empower the pet owner to take a more
collaborative and proactive role in supporting
the wellness care of their pet. It can be a force
multiplier in preventive pet health care because
it offers several enhancements and distinct
advantages over a conventional wellness exam
(Table 1).
• The PWR collects clinically relevant client
input in the form of a standardized
questionnaire, an assessment tool that goes
beyond what a typical patient history provides
in the usual amount of time available for a
canine or feline wellness exam.
• The PWR can also include comprehensive
laboratory screening that contains several
tests often omitted from a basic wellness
diagnostic workup.
• The client receives an easy-to-read,
customized Health Risk Assessment report
for their pet.
In this clinical trial, the PWR-enhanced exam
revealed new diagnostic findings in more than a
third of patients that were found to be clinically
normal by the same practice within the
preceding three months, generating approxi-
mately $125 per patient in new product and
service revenue for treating new medical
diagnoses. In the survey of trial participants,
both veterinarians and clients were unambigu-
ous in affirming the benefits and value of the
PWR. The trial confirmed that the PWR can be
an important contributor to the clinical and
economic success of the practice and a positive
factor in client perception of value.
This link between good medicine and good
business was emphasized by Dr. Michael
Cavanaugh in the March 2013, American Animal
Hospital Association (AAHA) State of the
Industry presentation. Cavanaugh remarked,
“Growing revenue is a sign of creating value
through the delivery of high quality patient care.
And when a practice grows revenue, it is able to
invest in itself, which in turn leads to improved
patient care” (Cavanaugh, 2013). The American
Animal Hospital Association has recommended
the Pet Wellness Report by endorsing it as the
only AAHA Preferred Business Provider in the
Health Risk Assessment category.
The PWR HRA process is a service tool that is
well-suited to promote the beliefs and habits
necessary for veterinarians with a wellness focus
to consistently excel within the current economy
and with modern-day pet owner value
expectations. We propose that repeating the
PWR HRA process every 6-12 months, would
provide more Lifelong Care (Ackerman et al,
2013) opportunities for the pet, pet owner,
and practice.
The PWR can be
used to engage,
educate, and
empower the pet
owner to take a
more collaborative
and proactive role in
supporting the
wellness care of
their pet.

15. REFERENCES
Ackerman L, Ball E, Brunt J, et al. The Zoetis
Lifelong Care Initiative: Putting the promise into
practice. North American Veterinary Conference
(NAVC) Clinician’s Brief. http://www.
cliniciansbrief.com/article/zoetis-lifelong-care-
initiative-putting-promise-practice. Published
July 2013. Accessed February 25, 2015.
American Animal Hospital Association. The path
to high-quality care: Practical tips for improving
compliance. Lakewood, CO: American Animal
Hospital Association; 2003.
American Animal Hospital Association.
Compliance: Taking quality care to the next level.
Lakewood, CO: American Animal Hospital
Association; 2009.
American Animal Hospital Association-American
Veterinary Medical Association Preventive
Healthcare Guidelines Task Force. Development
of new canine and feline preventive healthcare
guidelines designed to improve pet health. J Am
Anim Hosp Assoc 2011;47:306-311.
AAHA Lifestyle Assessment Forms (pet, canine,
feline). American Animal Hospital Association
(AAHA) Web site. https://www.aahanet.org/
Library/Flea_and_Tick.aspx. Published
December 12, 2013. Accessed February 25, 2015.
APPA Pet Industry Market Size & Ownership
Statistics, U.S. Pet Industry Spending Figures &
Future Outlook. http://www.americanpet
products.org/press_industrytrends.asp.
Accessed February 25, 2015.
Cavanaugh, M. AAHA State of the Veterinary
Profession. https://www.aaha.org/public_
documents/professional/resources/aaha_state_
of_the_industry_2013_white_paper.pdf.
Published March 2013. Accessed February 25,
2015.
15
Chmiel D, Cavanaugh M, McFarland JM,
Gannon T. Wellness: A Necessary Focus.
AAHA Web Conference Dec. 8-21, 2014.
https://www.aaha.org/professional/education/w
eb_conference.aspx?key=51B53CA9-82D7-
4A63-8D1B-C88CE3EF6CAD#gsc.tab=0.
Accessed Dec 10, 2014.
Goetzel RZ, Staely P, Ogden L, et al. A
Framework for Patient-Centered Health Risk
Assessments: Providing Health Promotion and
Disease Prevention Services to Medicare
Beneficiaries. Atlanta, GA: US Department of
Health and Human Services, Centers for Disease
Control and Prevention; 2011.
http://www.cdc.gov/policy/ohsc/hra/. Accessed
February 25, 2015.
Knesl O, Lavan R, Horter D, et al. Pet Wellness
Report. Canine Health Risk Assessment - A
Review of 7,827 Cases. Technical Bulletin, Zoetis.
May, 2013.
Lavan R, Knesl O, Holzhauer J, et al. Pet
Wellness Report. A Feline Health Risk Assess-
ment (A review of 1,197 cases). Technical
Bulletin, Zoetis. March, 2014.
Volk JO, Felsted KE, Thomas JG, et al. Executive
summary of the Bayer veterinary care usage
study. J Am Vet Med Assoc 2011;238:1275-1282.
Data on file, Pet Wellness Report Pricing
Solutions Pricing Study, 2013 Zoetis Inc.
Acknowledgments
The authors acknowledge the contribution of
Mark Dana of Scientific Communications, LLC,
in the preparation of this report. Additional
contribution acknowledgments include:
Deb Amodie of Zoetis Outcomes Research for
data analysis, Dr. Amy Pavlock, consultant as
study co-director, and Dr. Heather Loenser,
consultant editor.

16. ADDENDUM A
All trademarks are the property of Zoetis Inc., its affiliates and/or its licensors.
All other trademarks are the property of their respective owners.
PWR-00079 ©2015 Zoetis Inc. All rights reserved. March 2015.
Pet Owner Responses to Selected Health Risk Assessment Questions
in the Pet Wellness Report Clinical Trial
As a clinician, what would you do with this pet lifestyle and observational information
provided by the pet owner?
CANINE Questions from the PWR
Pet owners that said
Percentage
“YES’ to question
Dog shows one or more heart disease warning signs 34/465 7%
Pet owner has been late or missed doses of heartworm medication 180/465 39%
Dog has one or more signs of oral disease 133/465 29%
Dog demonstrates one or more signs of arthritis 79/465 17%
Dog demonstrates one or more skin signs of allergic disease 142/465 31%
FELINE Questions from the PWR
Pet owners that said
Percentage
“YES” to question
Cat regularly spends time outside 24/124 19%
Does your cat ever go outside? 39/124 31%
Cat shows one or more heart disease warning signs 11/124 9%
Cat shows one or more oral disease warning signs 28/124 23%
Cat demonstrates one or more signs of arthritis 15/124 12%
Cat demonstrates one or more skin signs of allergic disease 11/124 9%
Pet Owner is concerned about fleas/ticks infesting their cat (31/124) 25%
Pet Owner currently uses flea/tick medications on their cat (59/124) 48%