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

描述（由申请人提供）：虽然有明确的证据支持预防保健对健康的好处，但美国人只接受了50%的指示性预防服务。存在许多患者、临床医生和卫生保健系统障碍，导致在提供高质量预防保健方面存在这种差距。我们假设一个名为“我的预防保健”的交互式预防健康记录（IPHR）将增加推荐的筛查测试、免疫接种和咨询的提供。ipr将作为一种高度复杂的预防个人健康记录，将患者与其初级保健医生的电子记录中的健康信息直接联系起来。通过提供量身定制的建议、与教育资源和决策辅助工具的链接以及患者和临床医生的提醒，国际健康档案的功能将超越个人健康记录的功能。第一年将专注于更新和完善现有的IPHR原型。第二年和第三年，将通过一项随机对照试验来检验IPHR的有效性。结果将包括：(1)公共卫生报告是否增加了推荐的预防服务的提供；(2)参与者是否使用IPHR；(3) ipr是否增加了共同决策，改善了医患沟通。该研究将在弗吉尼亚门诊护理结果网络（ACORN）的七个初级保健实践中进行，这些实践使用通用电子病历（EMR）。从这些诊所的22.8万名患者中随机抽取5500名样本，按年龄和性别分层，按一对一的比例分配给他们，接受临床医生的要求，使用IPHR（干预组）或接受“常规”预防护理（对照组）。一份使用标准化问题来评估预防保健服务的预防服务调查将邮寄给4500名患者，CAHPS的临床医生和小组调查将邮寄给1000名患者。调查将在干预前、干预后6个月和干预后18个月邮寄。预防保健的提供将通过预防服务调查和电子病历数据来衡量，而共同决策和医患沟通将通过CAHPS调查来衡量。对照组和干预组从基线到干预后6个月和18个月的变化将进行比较。设想了一项利用一系列场所的积极传播计划，以将《国际卫生条例》的使用扩展到其他环境和其他电子病历。

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.