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的健康益处，但美国人只接受了50%的指定预防服务。患者、临床医生和卫生保健系统存在许多障碍，导致在提供高质量预防保健方面存在差距。我们假设，一个互动的预防性健康记录（IPHR），称为“我的预防保健”，将增加推荐的筛选测试，免疫接种和咨询的交付。IPHR将作为一个高度复杂的个人健康记录用于预防，将患者直接与其初级保健医生的电子记录中的健康信息联系起来。IPHR的功能将通过提供量身定制的建议、与教育资源和决策辅助的链接以及患者和临床医生的提醒而扩展到个人健康记录之外。第一年的重点是更新和完善现有的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。成果将包括：（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;（3）IPHR是否增加了共同决策并改善了临床医生与患者的沟通。该研究将在弗吉尼亚州门诊护理结果网络（ACORN）的七个初级保健实践中进行，这些实践使用通用的电子病历（EMR）。从228，000名患者中随机选择5，500名患者，按年龄和性别分层，将以一比一的比例分配，以接受临床医生使用IPHR（干预组）或接受“常规”预防护理（对照组）的请求。将向4 500名患者邮寄预防服务调查，使用标准化问题评估预防护理的提供情况，并向1 000名患者邮寄CAHPS临床医生和团体调查。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。一个积极的传播计划，使用一系列的场地，设想扩大使用的IPHR到其他设置和其他EMR。

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.