MyPreventiveCare: implementation and dissemination of an interactive preventive health record in three practice-based research networks serving disadvantaged patients-a randomized cluster trial
MyPreventiveCare: implementation and dissemination of an interactive preventive health record in three practice-based research networks serving disadvantaged patients-a randomized cluster trial
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DOI：
10.1186/s13012-014-0181-1
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发表时间：
2014-12-11
影响因子：
7.2
通讯作者：
Woolf, Steven H.
中科院分区：
文献类型：
--
作者：
Krist, Alex H.;Aycock, Rebecca A.;Woolf, Steven H.
背景资料：早期发现癌症和其他健康状况的循证预防服务提供了深刻的健康益处，但美国人只获得了一半的指定服务。政策倡议促进采用信息技术，让病人参与护理。我们开发了一个理论驱动的互动式预防性健康记录（IPHR），让患者参与健康促进。该模型定义了五个级别的功能：（1）收集患者信息，（2）与电子健康记录（EHR）集成，（3）将信息翻译成非专业语言，（4）提供个性化的，基于指南的临床建议，以及（5）促进患者行动。据推测，具有这些较高功能水平的个人健康记录（PHR）将以简单PHR无法实现的方式通知和激活患者。然而，实现这一愿景需要技术进步和有效实施的基础上，临床医生和实践engagement.Methods/design：我们正在开始一个两阶段，混合方法的试验，以评估是否IPHR是可扩展的大量的做法，以及如何摄取不同的少数民族和弱势患者。在第一阶段，来自三个基于实践的研究网络的40个实践将被随机分配，以将IPHR功能添加到他们的PHR中，而不是继续使用他们现有的PHR。在整个研究过程中，我们将参与干预实践，以本地定制IPHR内容，并学习如何将新功能整合到他们的实践工作流程中。在第2阶段，IPHR将所有非干预性实践纳入，以观察IPHR是否可以更广泛地实施（可扩展性）。第1阶段将根据RE-AIM模型对干预实践进行实施评估，以衡量覆盖范围（患者创建IPHR账户）、采用（使用IPHR的实践决策）、实施（一致性、保真度、障碍和使用促进者）和维护（持续使用）。与传统PHR相比，IPHR对接受癌症筛查检测和共同决策的增量效应将评估有效性。在第2阶段，我们将评估类似的结果，作为第1阶段，除了effectiveness.Discussion：这项研究将产生新的健康信息技术的有效性，旨在积极参与患者的护理，以及如何有效地实施和传播PHR的信息，通过从事临床医生。
Background: Evidence-based preventive services for early detection of cancer and other health conditions offer profound health benefits, yet Americans receive only half of indicated services. Policy initiatives promote the adoption of information technologies to engage patients in care. We developed a theory-driven interactive preventive health record (IPHR) to engage patients in health promotion. The model defines five levels of functionality: (1) collecting patient information, (2) integrating with electronic health records (EHRs), (3) translating information into lay language, (4) providing individualized, guideline-based clinical recommendations, and (5) facilitating patient action. It is hypothesized that personal health records (PHRs) with these higher levels of functionality will inform and activate patients in ways that simpler PHRs cannot. However, realizing this vision requires both technological advances and effective implementation based upon clinician and practice engagement.Methods/design: We are starting a two-phase, mixed-method trial to evaluate whether the IPHR is scalable across a large number of practices and how its uptake differs for minority and disadvantaged patients. In phase 1, 40 practices from three practice-based research networks will be randomized to add IPHR functionality to their PHR versus continue to use their existing PHR. Throughout the study, we will engage intervention practices to locally tailor IPHR content and learn how to integrate new functions into their practice workflow. In phase 2, the IPHR to all nonintervention practices to observe whether the IPHR can be implemented more broadly (Scalability). Phase 1 will feature an implementation assessment in intervention practices, based on the RE-AIM model, to measure Reach (creation of IPHR accounts by patients), Adoption (practice decision to use the IPHR), Implementation (consistency, fidelity, barriers, and facilitators of use), and Maintenance (sustained use). The incremental effect of the IPHR on receipt of cancer screening tests and shared decision-making compared to traditional PHRs will assess Effectiveness. In phase 2, we will assess similar outcomes as phase 1 except for effectiveness.Discussion: This study will yield information about the effectiveness of new health information technologies designed to actively engage patients in their care as well as information about how to effectively implement and disseminate PHRs by engaging clinicians.