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

交互式预防性健康记录 (IPHR) 促进以患者为中心的护理

• 批准号: 7490945
• 负责人: Alexander H Krist
• 金额: $ 33.1万
• 依托单位: VIRGINIA COMMONWEALTH UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-01 至 2010-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7490945
• 关键词: Interactive; Preventive; Health; Record; IPHR

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.

描述(由申请人提供)：虽然有明确的证据支持预防保健的健康益处，但美国人只得到了指定预防服务的50%。存在大量患者、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出现这种差距。我们假设，一种称为“我的预防保健”的互动式预防健康记录(IPHR)将增加推荐的筛查测试、免疫接种和咨询的提供。IPHR将作为用于预防的高度复杂的个人健康记录，将患者直接链接到其初级保健医生的电子记录中的他们的健康信息。IPHR的功能将扩展到个人健康记录之外，提供量身定制的建议、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。第一年将重点更新和完善现有的IPHR原型。第二年和第三年，通过随机对照试验，将检查IPHR的有效性。结果将包括：(1)IPHR是否增加了推荐的预防服务的提供；(2)参与者是否使用IPHR；以及(3)IPHR是否增加了共同决策和改善临床医生与患者的沟通。这项研究将在弗吉尼亚州动态护理结果网络(ACORN)的七个初级保健实践中进行，这些实践利用共同的电子医疗记录(EMR)。从228000名患者中随机选择5500名患者，按年龄和性别分层，将以一对一的比例分配给他们的临床医生，接受他们使用IPHR的请求(干预组)或接受“常规”预防护理(控制组)。将向4500名患者邮寄预防性服务调查，该调查使用标准化问题来评估预防护理的提供情况，并将向1000名患者邮寄CAHPS临床医生和小组调查。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EMR数据来衡量，而共同决策和临床医生与患者的沟通将通过CAHPS调查来衡量。将比较对照组和干预组从基线到干预后6个月和18个月的变化。设想了一项积极的传播计划，利用一系列场所，将IPHR的使用扩展到其他环境和其他EMR。