An Interactive Preventive Health Record (IPHR) to Promote Patient-Centered Care

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DESCRIPTION (provided by applicant): While there is clear evidence supporting the health benefits of preventive care, Americans only receive 50% of indicated preventive services. A host of patient, clinician, and health care system barriers exist, contributing to this gap in delivery of quality preventive care. We hypothesize that an interactive preventive health record (IPHR), called "My Preventive Care", will increase the delivery of recommended screening tests, immunizations, and counseling. The IPHR will function as a highly sophisticated personal health record for prevention, linking patients directly to their health information in the electronic record of their primary care physician. The functions of the IPHR will extend beyond those of personal health records by providing tailored recommendations, links to educational resources and decision aids, and patient and clinician reminders. Year One will focus on updating and refining an existing IPHR prototype. The second and third year, through a randomized controlled trial, will examine the effectiveness of the IPHR. Outcomes will include: (1) whether the IPHR increases the delivery of recommended preventive services; (2) whether participants use the IPHR; and (3) whether the IPHR increases shared decision-making and improves clinician-patient communication. The study will take place in seven primary care practices in the Virginia Ambulatory Care Outcomes Network (ACORN) that utilize a common electronic medical record (EMR). A randomly selected sample of 5,500 of the practices' 228,000 patients, stratified by age and gender, will be assigned in a one-to-one ratio to receive a request from their clinicians to use the IPHR (intervention group) or to receive "usual" preventive care (control group). A Preventive Services Survey, which uses standardized questions to evaluate the delivery of preventive care, will be mailed to 4,500 patients and the CAHPS Clinician and Group Survey will be mailed to 1,000 patients. Surveys will be mailed pre-intervention, 6 months post-intervention, and 18 months post-intervention. Delivery of preventive care will be measured by the Preventive Services Survey and EMR data, while shared decision-making and clinician-patient communication will be measured by the CAHPS survey. The change from baseline to 6 and 18 months post-intervention for the control and intervention groups will be compared. An aggressive dissemination plan using a range of venues is envisioned to extend the use of the IPHR to other settings and to other EMRs.