Conversational IT for Better, Safer Pediatric Primary Care

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A large gap exists between what is recommended for effective primary care of children and what actually takes place in pediatric primary care settings, especially in the areas of preventive care. Furthermore, although medication management (safety and effectiveness) issues have emerged as an important factor for children, little is known about how medication is actually used by families at home. Interactive telephony technologies offer a potentially highly effective, patient-centered communication modality by guiding parents at home through interactive discussions that can gather information and actively reinforce recommendations and treatments. Interactive telephony systems are particularly well suited for use in vulnerable populations since access to the telephone is nearly universal, and the system does not rely on reading printed text. We propose to develop and evaluate an integrated patient-centered health information system, the Personal Health Partner (PHP). The PHP will use fully automated, interactive, conversations to gather personal health data and counsel parents before scheduled visits, exchange that data with the child?s primary care clinician via the electronic health record (EHR), and offer personalized follow-up assessment and counseling after visits. The Personal Health Partner System will be evaluated in a randomized clinical trial to determine whether when compared to usual care: 1) PHP preventive and medication management assessments (without counseling) combined with EHR data exchange lead to higher quality preventive care and medication management; and 2) PHP with automated counseling is also associated with increased parental activation and healthier parental behaviors. We will also explore whether: 1) use of the PHP system will be feasible for parents and clinicians; 2) parents with low health literacy are able to use the PHP system as effectively as those with higher health literacy; 3) parents who receive PHP assessments with counseling are more likely to be counseled or change their behavior than those who receive PHP assessment only; and 4) the PHP system can automatically detect medications errors following new prescriptions in primary care settings. The IT-based approach to be evaluated in this project will link parents and children outside the clinical setting with their primary care center and will offer comprehensive assessments AND counseling to reinforce and support parental behavior change. With growing use of the EHR come new opportunities to link patient-centered information with clinical health information systems. Linkage of these systems has the potential to inform and activate parents, provide much richer data to drive decision support at the point-of-care, and to provide ongoing support for long-term behavior change following primary care visits. The use of conversational technologies as the foundation for the project offers a number of unique advantages especially the support of lower-literacy populations and near-universal access. Systems like the PHP represent a model for the future of ambulatory care and the sustainable, affordable delivery of higher quality and safer care by primary care clinicians in the future.