Impact of a Wellness Portal on the Delivery of Patient-Centered Prospective Care

描述（由申请人提供）：随着推荐的预防性服务的数量不断增加，临床医生努力在患者的直接关注和解决预防所需的时间之间保持平衡。很明显，如果没有有效和及时的临床决策支持集成到一个全面的护理提供方法（如慢性病护理模式），没有以患者为中心的定制建议，初级保健临床医生在这方面的表现很可能从次优（40-60%的比率提供广泛接受的预防服务）到不满意。初级、二级和三级预防服务的最佳提供将越来越需要复杂的信息处理和更多的患者参与。尽管以病人为中心的交付方法的重要性，但是，有有限的信息提供的综合卫生信息技术（HIT）的影响，以病人为中心，在初级保健机构的预防保健。我们建议进行一项为期三年的有系统研究，目的如下：1）发展、实地测试及改善一个与预防服务提醒系统相连的网上病人健康入门网站，以促进基层医疗服务以病人为中心的预防服务; 2）通过检查患者和提供者的行为和经验以及推荐服务的个性化程度，确定健康门户网站对以患者为中心的预防性护理过程的影响;以及3）发展健康门户网站的示范做法，并传播从目标1和2的研究结果中得出的健康门户网站技术和知识。由于健康门户方法，我们预计，激活的患者和转变的医疗实践将更有可能参与积极主动的，以患者为中心的护理，这将导致在正确的时间向正确的患者提供更一致的适当预防服务。

DESCRIPTION (provided by applicant): As the number of recommended preventive services continues to increase, clinicians struggle to maintain a balance between immediate patient concerns and the time required to address prevention. It is clear that without effective and timely clinical decision support integrated into a comprehensive care delivery approach (e.g. the Chronic Care Model) and without patient-centered tailoring of recommendations, primary care clinicians' performance in this area is likely to go from suboptimal (40-60% rates of delivery of well-accepted preventive services) to unsatisfactory. Optimal delivery of primary, secondary, and tertiary preventive services will increasingly require sophisticated information processing and much greater patient involvement. Despite the importance of patient-centered delivery approaches, however, there is limited information available on the impact of integrated health information technologies (HIT) on the delivery of patient centered, preventive care in primary care settings. Building upon our experience with a very sophisticated preventive services prompt and reminder system, the Preventive Services Reminder System (PSRS), we propose to conduct a systematic three-year study with the following aims: 1) To develop, field test, and refine an Internet-based patient Wellness Portal linked to PSRS to facilitate patient-centered, preventive care in primary care practices; 2) To determine the impact of the Wellness Portal on the process of patient-centered preventive care by examining the behavior and experiences of both patients and providers and the degree to which recommended services are individualized; and 3) To develop model Wellness Portal practices and disseminate the Wellness Portal technology and knowledge derived from findings from Aims 1 and 2. As a result of the Wellness Portal approach, we expect that activated patients and transformed medical practices will be more likely to engage in proactive, patient-centered care, and that this will result in more consistent delivery of appropriate preventive services to the right patients at the right times.