Promoting Use of an Integrated Personal Health Record for Prevention

促进使用综合个人健康记录进行预防

• 批准号: 7873921
• 负责人: Alexander H Krist
• 金额: $ 16万
• 依托单位: VIRGINIA COMMONWEALTH UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-06-16 至 2012-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7873921
• 关键词: Promoting; Use; Integrated; Personal; Health

DESCRIPTION (provided by the applicant): Personal health records (PHRs) integrated with electronic medical records (EMRs) are an essential tool to promote patient-centered care and ultimately improve health outcomes. Although adoption and use of integrated PHRs is increasing, it typically occurs within large integrated healthcare systems that have business models supporting their use. Whether such systems can have broad uptake in typical primary care practices remains unknown. In a previous AHRQ-funded R18, we created a PHR for prevention that is integrated with a clinician's EMR, which we term an "interactive preventive healthcare record" (IPHR). The IPHR also incorporates clinical decision support software, a reminder system, tailored educational materials, and decision aids into one actionable package for both patients and clinicians. In a study that tested IPHR feasibility and effect, the IPHR enhanced clinician-patient communication and promoted the delivery of recommended preventive services. Although these findings are encouraging, the study design permitted only small subsets of the study practices' patients to be included and patients were introduced to the IPHR with only a low- intensity invitational letter. The next logical step is to conduct a feasibility trial to assess whether practices can, under usual practice conditions, sustainably and more intensively integrate the IPHR into care. We propose to test the question in eight practices in the Virginia Ambulatory Care Outcomes Research Network (ACORN) that participated in the first study. All adult patients presenting for care will be considered eligible for IPHR use. Guided by organizational change theory, we will engage practices to create a shared vision on how to integrate the IPHR into care delivery using practice champions, learning collaboratives, and a patient-centered communications strategy. From the IPHR and EMR databases, we will apply the RE-AIM model to measure Reach, Effectiveness, Implementation, and Maintenance. We define Reach as the proportion and characteristics of patients seen for an office visit who establish an IPHR account and receive prevention recommendations, Effectiveness as change in documented preventive service delivery after patients use the IPHR, Implementation as clinician response to IPHR-identified patient needs, practice-level Maintenance as the practice's ability to sustain Reach 6 to 12 months after initial PHR fielding, and patient-level Maintenance as whether patients continue to use the IPHR after 6 months. We will compare the Reach in practices promoting the IPHR to patients using the integrated approach to the historical control rate of the less intensive invitational letter; the eight study sites will provide 80% power, using a one-sided 0.05-level test to detect a 10% incremental increase. We will conduct key informant interviews and record and analyze learning collaboratives to understand how practices integrated the IPHR and mediators and moderators to use. Findings from this study will assist in the design of a future practice-level randomized controlled trial, and inform practices, policymakers, and payers about how to integrate a PHR in typical primary care practices. Patient-centered health information technology systems, such as integrated personal health records, have great potential to improve the quality of care by providing centralized medical information, patient education and activation, enhanced patient and clinician communication, decision support, and reminder systems. However, these systems cannot improve health if they are not used by patients and clinicians. We seek to learn whether primary care practices can encourage patients to use such a system by integrating it into routine care and to determine how the intervention influences healthcare delivery

描述（由申请人提供）：与电子病历（EMR）集成的个人健康记录（PHR）是促进以患者为中心的护理并最终改善健康结果的重要工具。虽然集成PHR的采用和使用正在增加，但它通常发生在具有支持其使用的业务模型的大型集成医疗保健系统中。这种系统是否能在典型的初级保健实践中得到广泛应用仍是未知数。在之前AHRQ资助的R18中，我们创建了一个用于预防的PHR，该PHR与临床医生的EMR相结合，我们称之为“交互式预防性医疗记录”（IPHR）。IPHR还将临床决策支持软件、提醒系统、定制的教育材料和决策辅助工具整合到一个可操作的软件包中，供患者和临床医生使用。在一项测试IPHR可行性和效果的研究中，IPHR加强了临床医生与患者的沟通，并促进了推荐的预防服务的提供。尽管这些发现令人鼓舞，但研究设计仅允许纳入研究实践患者的一小部分，并且仅通过低强度邀请函将患者介绍给IPHR。下一个合乎逻辑的步骤是进行可行性试验，以评估在通常的实践条件下，实践是否可以可持续地和更深入地将IPHR纳入护理。我们建议在参与第一项研究的弗吉尼亚州门诊护理结果研究网络（ACORN）的八个实践中测试这个问题。所有接受治疗的成年患者都将被视为有资格使用IPHR。在组织变革理论的指导下，我们将参与实践，以创建一个共同的愿景，即如何将IPHR整合到使用实践冠军，学习协作者和以患者为中心的沟通策略的医疗服务中。从IPHR和EMR数据库中，我们将应用RE-AIM模型来衡量覆盖范围、有效性、实施和维护。我们将达到定义为建立IPHR账户并接受预防建议的门诊就诊患者的比例和特征，有效性定义为患者使用IPHR后记录的预防服务提供的变化，实施定义为临床医生对IPHR确定的患者需求的响应，实践水平维持定义为实践在初始PHR部署后6至12个月维持达到的能力，患者水平维持是指患者在6个月后是否继续使用IPHR。我们将使用整合方法将在向患者推广IPHR的实践中的Reach与强度较低的邀请函的历史对照率进行比较; 8家研究中心将提供80%的把握度，使用单侧0.05水平检验检测10%的增量增加。我们将进行关键的线人访谈，并记录和分析学习协作，以了解如何将IPHR和调解员和主持人整合到一起使用。这项研究的结果将有助于设计未来的实践水平的随机对照试验，并告知实践，决策者和支付者如何将PHR整合到典型的初级保健实践中。以患者为中心的健康信息技术系统，例如集成的个人健康记录，通过提供集中的医疗信息、患者教育和激活、增强的患者和临床医生沟通、决策支持和提醒系统，具有提高护理质量的巨大潜力。然而，如果患者和临床医生不使用这些系统，它们就不能改善健康。我们试图了解初级保健的做法是否可以鼓励病人使用这样一个系统，将其纳入日常护理，并确定如何干预影响医疗服务