Opportunities and Challenges When Using the Electronic Health Record for Practice-Integrated Patient-Facing Interventions: The e-Assist Colon Health Randomized Trial.
Opportunities and Challenges When Using the Electronic Health Record for Practice-Integrated Patient-Facing Interventions: The e-Assist Colon Health Randomized Trial.
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DOI：
10.1177/0272989x221104094
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发表时间：
2022-11
影响因子：
3.6
通讯作者：
Hawley, Sarah
中科院分区：
文献类型：
--
作者：
Lafata, Jennifer Elston;Shires, Deirdre A.;Shin, Yongyun;Flocke, Susan;Resnicow, Kenneth;Johnson, Morgan;Nixon, Ellen;Sun, Xinxin;Hawley, Sarah
即使在医生的建议下，许多人仍然没有进行结直肠癌（CRC）筛查。电子健康记录（EHRs）和固定在线门户的激增可能提供新的机会，将面向患者的干预措施嵌入到诊所工作流程中，并使患者按照医生的建议进行护理。我们评估了一项面向患者的干预措施的有效性，该干预措施旨在补充基于医生办公室的CRC筛查建议。通过一项两组实用的随机临床试验，我们评估了EHR中记录的干预对CRC筛查使用的影响（主要结局）以及干预对目标人群的影响程度。试验参与者年龄在50至75岁之间，有保险，并有医生建议进行结直肠癌筛查。典型的EHR功能（包括患者注册、健康维护标志、最佳实践警报和安全消息传递）用于支持与研究相关的活动，并将干预措施交付给登记的患者。共有1825名成年人同意参加试验，其中78%完成了基线调查并接受了干预。大多数试验参与者（bbb80 %）表示有意在基线调查中进行筛查，65%在随访中进行了筛查，各组间无显著差异。三分之一符合条件的患者收到了安全信息。其中，超过四分之三的人查阅了学习材料。通过利用常见的电子病历功能，我们在诊所工作流程中集成了面向患者的干预。尽管整合了实践，干预并没有改善筛查的使用，部分原因可能是基于门户的干预没有达到那些干预可能最有效的人。在电子病历中嵌入面向患者的干预措施可以实现实践整合，但可能会由于缺少患者群体的重要部分而降低项目有效性。电子健康记录工具可用于促进实践嵌入式实用试验和面向患者的干预过程，包括患者识别、研究分组分配和干预交付。根据医生的建议，在线门户嵌入干预并没有提高结直肠癌（CRC）筛查的接受程度，部分原因可能是门户用户往往已经高度参与医疗保健。仅依靠患者门户网站进行结直肠癌筛查干预可能不会改变筛查的使用，并可能加剧众所周知的护理差距。
Even after a physician recommendation, many people remain unscreened for colorectal cancer (CRC). The proliferation of electronic health records (EHRs) and tethered online portals may afford new opportunities to embed patient-facing interventions within clinic workflows and engage patients following a physician recommendation for care. We evaluated the effectiveness of a patient-facing intervention designed to complement physician office-based recommendations for CRC screening. Using a 2-arm pragmatic, randomized clinical trial, we evaluated the intervention’s effect on CRC screening use as documented in the EHR (primary outcome) and the extent to which the intervention reached the target population. Trial participants were insured, aged 50 to 75 y, with a physician recommendation for CRC screening. Typical EHR functionalities, including patient registries, health maintenance flags, best practice alerts, and secure messaging, were used to support research-related activities and deliver the intervention to enrolled patients. A total of 1,825 adults consented to trial participation, of whom 78% completed a baseline survey and were exposed to the intervention. Most trial participants (>80%) indicated an intent to be screened on the baseline survey, and 65% were screened at follow-up, with no significant differences by study arm. One-third of eligible patients were sent a secure message. Among those, more than three-quarters accessed study material. By leveraging common EHR functionalities, we integrated a patient-facing intervention within clinic workflows. Despite practice integration, the intervention did not improve screening use, likely in part due to portal-based interventions not reaching those for whom the intervention may be most effective. Embedding patient-facing interventions within the EHR enabled practice integration but may minimize program effectiveness by missing important segments of the patient population. Electronic health record tools can be used to facilitate practice-embedded pragmatic trial and patient-facing intervention processes, including patient identification, study arm allocation, and intervention delivery. The online portal-embedded intervention did not improve colorectal cancer (CRC) screening uptake following a physician recommendation, likely in part because portal users tend to be already highly engaged with healthcare. Relying on patient portals alone for CRC screening interventions may not alter screening use and could exacerbate well-known care disparities.
影响因子：
5.4
作者：
Tabriz AA;Flocke SA;Shires D;Dyer KE;Schreiber M;Elston Lafata J
通讯作者：
Elston Lafata J
影响因子：
5.5
作者：
Woolf SH;Krist AH;Lafata JE;Jones RM;Lehman RR;Hochheimer CJ;Sabo RT;Frosch DL;Zikmund-Fisher BJ;Longo DR
通讯作者：
Longo DR
影响因子：
6.2
作者：
Lairson, David R.;DiCarlo, Melissa;Deshmuk, Ashish A.;Fagan, Heather B.;Sifri, Randa;Katurakes, Nora;Cocroft, James;Sendecki, Jocelyn;Swan, Heidi;Vernon, Sally W.;Myers, Ronald E.
通讯作者：
Myers, Ronald E.