Implementing Personal Health Records to Promote Evidence-Based Cancer Screening

实施个人健康记录以促进循证癌症筛查

• 批准号: 8506457
• 负责人: Alexander H Krist
• 金额: $ 63.69万
• 依托单位: VIRGINIA COMMONWEALTH UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-04 至 2018-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8506457
• 关键词: Accounting; Adherence; Adoption; Adult; American; Caring; Clinical; Clinical Trials Design; Data Sources; Databases; Disadvantaged; Effectiveness; Electronic Health Record; Focus Groups; Future; Government; Guidelines; Health; Health Benefit; Health Promotion; Information Resources; Information Systems; Information Technology; Intervention; Language; Learning; Length; Link; Maintenance; Measures; Medicaid; Methods; Metric; Minority; Modeling; Office Visits; Patients; Perception; Personal Health Records; Phase; Phase II Clinical Trials; Policies; Population; Prevention; Preventive; Primary Health Care; Quality of life; Randomized; Recommendation; Records; Relative (related person); Reporting; Resources; Screening for cancer; Services; Site; Societies; System; Technology; Testing; Transcript; Translating; Underrepresented Minority; Variant; Virginia; Vision; Work; base; beneficiary; cancer prevention; comparative effectiveness; design; diaries; effectiveness trial; empowered; evidence base; evidence based guidelines; experience; field survey; health record; improved; innovation; medical specialties; patient oriented; practice-based research network; public health relevance; shared decision making; theories; tool; uptake

DESCRIPTION (provided by applicant): Evidence-based preventive services for the early detection of cancer and other health conditions offer profound health benefits, yet Americans receive only half of indicated services. Government and specialty society policy initiatives are promoting the adoption of information technologies to engage patients in their care, such as personal health records (PHRs), but the current functionality may not fully utilize the technology's potential. We developed a theory-driven interactive PHR that uses its higher functionality to more deeply engage patients in health promotion. The model defines five levels of PHR 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. We hypothesize that implementing PHRs with these higher levels of functionality will inform and activate patients in ways that simpler PHRs cannot achieve and will increase uptake of preventive services. However, realizing this vision in practice requires both technological upgrades and practice engagement. Our prior work in Virginia practices demonstrated that patients who used such a system were more up-to-date with preventive care. We now propose a 2-phase trial to evaluate whether this functionality is scalable across a large number of practices and how its uptake differs for minority and disadvantaged patients. In Phase 1 (years 2-3), we will randomize 46 practices from three practice-based research networks in eight states to implement a PHR with advanced versus simpler functionality. Control practices will use their existing PHR. Intervention practices will upgrade their PHR to feature an interactive preventive health record (IPHR) that we have previously developed and tested. Intervention practices will locally tailor the IPHR content and learn how to integrate new functions into practice. 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 randomized comparison of intervention and control practices will measure the incremental effect of the IPHR on shared decision-making and receipt of cancer screening tests compared to traditional PHRs (Effectiveness). Data sources will include the EHR/PHR/IPHR databases, patient and practice surveys, field notes, practice learning collaborative transcripts, practice diaries, and patient focus groups that oversample minorities. In Phase 2 (years 4-5), the networks will offer the IPHR to all (up to 278) non-intervention practices to observe whether the networks can implement the IPHR more broadly (Scalability). This study will inform future efforts to use patient-centered information technology to promote cancer prevention and the feasibility of national dissemination.

描述(由申请人提供)：为癌症和其他健康状况的早期检测提供的循证预防服务提供了巨大的健康益处，但美国人只获得了一半的指定服务。政府和专业协会的政策倡议正在推动采用信息技术来让患者参与到他们的护理中来，例如个人健康记录(PHR)，但目前的功能可能没有充分利用该技术的潜力。我们开发了一种理论驱动的交互式PHR，它使用更高的功能来更深入地让患者参与到健康促进中来。该模型定义了PHR功能的五个层次：(1)收集患者信息，(2)与电子健康记录(EHR)集成，(3)将信息翻译成通俗语言，(4)提供个性化的、基于指南的临床建议，(5)促进患者的行动。我们假设，实施具有这些更高水平的功能的PHR将以更简单的PHR无法实现的方式通知和激活患者，并将增加对预防服务的接受。然而，在实践中实现这一愿景需要技术升级和实践参与。我们之前在弗吉尼亚的工作实践表明，使用这种系统的患者更能及时了解预防护理。我们现在建议进行一个两阶段的试验，以评估这一功能是否可在大量实践中扩展，以及它对少数族裔和弱势患者的吸收有何不同。在第一阶段(第二年至第三年)，我们将从八个州的三个以实践为基础的研究网络中随机选择46个实践，以实施具有高级功能与简单功能的PHR。控制实践将使用其现有的PHR。干预实践将升级他们的PHR，以采用我们之前开发和测试的交互式预防健康记录(IPHR)。干预实践将在当地定制《国际公共卫生条例》的内容，并学习如何将新功能融入实践。第一阶段将以RE-AIM模型为基础，在干预实践中进行实施评估，以衡量REACH(患者创建IPHR账户)、采用(实践决定使用IPHR)、实施(一致性、保真度、障碍和使用促进者)和维护(持续使用)。干预和控制实践的随机比较将衡量与传统的PHR相比，IPHR在共享决策和接受癌症筛查测试方面的增量效应(有效性)。数据来源将包括EHR/PHR/IPHR数据库、患者和实践调查、实地笔记、实践学习协作成绩单、实践日记和过多抽样的患者焦点小组。在第二阶段(第4-5年)，网络将向所有(最多278个)不干预做法提供IPHR，以观察网络是否可以更广泛地实施IPHR(可扩展性)。这项研究将为未来利用以患者为中心的信息技术促进癌症预防的努力和在全国推广的可行性提供信息。