Implementing Personal Health Records to Promote Evidence-Based Cancer Screening

描述（由申请人提供）：用于早期发现癌症和其他健康状况的循证预防服务可带来深远的健康益处，但美国人只获得了一半的指定服务。政府和专业协会的政策举措正在促进采用信息技术来让患者参与护理，例如个人健康记录 (PHR)，但当前的功能可能无法充分利用该技术的潜力。我们开发了一种理论驱动的交互式 PHR，利用其更高的功能更深入地让患者参与健康促进。该模型定义了五个级别的 PHR 功能：(1) 收集患者信息，(2) 与电子健康记录 (EHR) 集成，(3) 将信息翻译成通俗语言，(4) 提供个性化、基于指南的临床建议，以及 (5) 促进患者采取行动。我们假设，实施具有这些更高级别功能的 PHR 将以更简单的 PHR 无法实现的方式告知和激活患者，并将增加预防性服务的采用。然而，要在实践中实现这一愿景，既需要技术升级，也需要实践参与。我们之前在弗吉尼亚州的实践工作表明，使用这种系统的患者能够更及时地了解预防性护理。我们现在提出一项两阶段试验，以评估该功能是否可以在大量实践中扩展，以及少数族裔和弱势患者对它的采用有何不同。在第一阶段（第 2-3 年），我们将从八个州的三个基于实践的研究网络中随机抽取 46 个实践，以实施具有高级功能与简单功能的 PHR。控制实践将使用现有的 PHR。干预实践将升级他们的 PHR，以采用我们之前开发和测试的交互式预防性健康记录 (IPHR)。干预实践将在本地定制 IPHR 内容，并学习如何将新功能融入实践。第一阶段将基于 RE-AIM 模型对干预实践进行实施评估，以衡量影响范围（患者创建 IPHR 账户）、采用（使用 IPHR 的实践决策）、实施（使用的一致性、保真度、障碍和促进因素）和维护（持续使用）。干预和控制实践的随机比较将衡量 IPHR 与传统 PHR 相比对共同决策和接受癌症筛查测试的增量影响（有效性）。数据源将包括 EHR/PHR/IPHR 数据库、患者和实践调查、现场笔记、实践学习协作记录、实践日记以及对少数群体进行过度抽样的患者焦点小组。在第 2 阶段（第 4-5 年），网络将向所有（最多 278 个）非干预实践提供 IPHR，以观察网络是否可以更广泛地实施 IPHR（可扩展性）。这项研究将为未来利用以患者为中心的信息技术促进癌症预防的努力以及全国传播的可行性提供信息。

DESCRIPTION (provided by applicant): Evidence-based preventive services for the early detection of cancer and other health conditions offer profound health benefits, yet Americans receive only half of indicated services. Government and specialty society policy initiatives are promoting the adoption of information technologies to engage patients in their care, such as personal health records (PHRs), but the current functionality may not fully utilize the technology's potential. We developed a theory-driven interactive PHR that uses its higher functionality to more deeply engage patients in health promotion. The model defines five levels of PHR functionality: (1) collecting patient information, (2) integrating with electronic health records (EHRs), (3) translating information into lay language, (4) providing individualized, guideline-based clinical recommendations, and (5) facilitating patient action. We hypothesize that implementing PHRs with these higher levels of functionality will inform and activate patients in ways that simpler PHRs cannot achieve and will increase uptake of preventive services. However, realizing this vision in practice requires both technological upgrades and practice engagement. Our prior work in Virginia practices demonstrated that patients who used such a system were more up-to-date with preventive care. We now propose a 2-phase trial to evaluate whether this functionality is scalable across a large number of practices and how its uptake differs for minority and disadvantaged patients. In Phase 1 (years 2-3), we will randomize 46 practices from three practice-based research networks in eight states to implement a PHR with advanced versus simpler functionality. Control practices will use their existing PHR. Intervention practices will upgrade their PHR to feature an interactive preventive health record (IPHR) that we have previously developed and tested. Intervention practices will locally tailor the IPHR content and learn how to integrate new functions into practice. Phase 1 will feature an implementation assessment in intervention practices, based on the RE-AIM model, to measure Reach (creation of IPHR accounts by patients), Adoption (practice decision to use the IPHR), Implementation (consistency, fidelity, barriers, and facilitators of use), and Maintenance (sustained use). The randomized comparison of intervention and control practices will measure the incremental effect of the IPHR on shared decision-making and receipt of cancer screening tests compared to traditional PHRs (Effectiveness). Data sources will include the EHR/PHR/IPHR databases, patient and practice surveys, field notes, practice learning collaborative transcripts, practice diaries, and patient focus groups that oversample minorities. In Phase 2 (years 4-5), the networks will offer the IPHR to all (up to 278) non-intervention practices to observe whether the networks can implement the IPHR more broadly (Scalability). This study will inform future efforts to use patient-centered information technology to promote cancer prevention and the feasibility of national dissemination.