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

描述（由申请人提供）：随着推荐的预防服务的数量不断增加，临床医生努力在患者直接关注和解决预防所需的时间之间保持平衡。很明显，如果没有将有效和及时的临床决策支持整合到综合护理提供方法中（例如慢性护理模式），并且没有以患者为中心的量身定制建议，初级保健临床医生在这一领域的表现可能会从次优（提供广泛接受的预防服务的40-60%的比率）变为不令人满意。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。然而，尽管以患者为中心的提供方法很重要，但关于综合卫生信息技术（HIT）对初级保健机构提供以患者为中心的预防性保健的影响的现有信息有限。基于我们在非常先进的预防服务提示和提醒系统——预防服务提醒系统（PSRS）方面的经验，我们建议开展一项为期三年的系统研究，目标如下：1)开发、实地测试和完善与PSRS相关联的基于互联网的患者健康门户网站，以促进初级保健实践中以患者为中心的预防保健；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，确定健康门户对以患者为中心的预防保健过程的影响；3)开发健康门户实践模型，传播健康门户技术和从目标1和目标2中获得的知识。健康门户方法的结果是，我们期望被激活的患者和经过改造的医疗实践将更有可能参与主动的、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的预防服务。

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.