Enhancing Electronic Health Systems to Decrease the Burden of Colon Cancer, Lung Cancer, Obesity, Vaccine-Preventable Illness, and Liver Cancer (CLOVER)

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PROJECT SUMMARY With the goal of improving medical care and reducing health disparities for the aging American population, the University of California, Davis (UCD) and University of California, Irvine (UCI) have collaborated to propose “Enhancing Electronic Health Systems to Decrease the Burden of Colon Cancer, Lung Cancer, Obesity, Vaccine-Preventable Illness, and LivER Cancer” (“CLOVER”). The overall goal of CLOVER is to develop, deliver, and disseminate electronic health systems (EHR)-based interventions that will improve the well-being of older adults through increasing the adherence to selected US Preventive Services Task Force (USPSTF) Grade A and Grade B recommendations and Centers for Disease Control and Prevention (CDC) vaccination recommendations. We will accomplish this goal through pilot (R61) and clinical trial (R33) phases using the following Specific Aims: Aim #1 (R61): Conduct Stage I Behavioral Intervention Development by algorithm development and testing of Epic Healthy Planet (HP) at UCD to identify patients at risk, but never screened for colon cancer or lung cancer. Aim #2 (R61 and R33): Utilizing the enhanced Epic HP, pilot-test evidence-based and customized interventions at both UCD and UCI to increase colon and lung cancer screening rate for at-risk individuals by 10%. Aim #3 (R61 and R33): Determine effectiveness of “bundled ordering” by assessing patients prior to their primary care visit for eligibility for colon and lung cancer screening, tobacco and obesity counseling, age-appropriate vaccination, and hepatitis C screening compared to single procedures in terms of time-saved. Aim #4 (R33): Conduct Stage IV Behavioral Intervention Development by expansion of CLOVER to the UCI federally qualified health center. Aim #5 (R61 and R33): Evaluate the impact of CLOVER on increasing adherence to selected USPSTF recommendations and reducing their disparities by demographic group. CLOVER will cleverly tailor Epic HP to institute 3 key interventions with multi-centered dissemination which will increase the aforementioned screenings, counseling, and vaccinations: 1) Electronic “bulk messaging” through the UCD patient-physician portal using messages that resonate by racial/ethnic groups, 2) “Bundled ordering” will be used by CLOVER staff to fulfill deficiencies in USPSTF and CDC recommendations simultaneously. This will include the use of the emerging technology video visits by which patients will connect to certified tobacco and obesity counselors using their smart phones without the need to travel to an appointment, and 3) “Tailored Health Maintenance” section in the patient's electronic medical chart will alert their PCP of remaining “care gaps” in USPSTF and CDC recommendations and facilitate shared decision making for patients who need additional counseling. If these Aims are achieved, adherence to USPSTF recommendations will be enhanced, and Epic, the EHR company who serves more than 250 million patients will consider incorporating CLOVER into its Foundation System for all organizations to consider adopting our approach.