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持续增加，临床医生努力在患者直接关注的问题和解决预防问题所需的时间之间保持平衡。显然，如果没有有效和及时的临床决策支持纳入全面的护理提供方法(例如慢性护理模式)，如果没有以患者为中心的建议定制，初级保健临床医生在这一领域的表现很可能从次优(接受良好的预防服务的提供率为40%-60%)变为不令人满意。一级、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交付方法很重要，但关于综合卫生信息技术(HIT)对初级保健环境中以患者为中心的预防性护理的交付的影响，可用的信息有限。基于我们在非常复杂的预防服务提示和提醒系统(PSRS)方面的经验，我们建议进行一项为期三年的系统研究，目标如下：1)开发、现场测试和完善与PSRS相连的基于互联网的患者健康门户，以促进初级保健实践中以患者为中心的预防性护理；2)通过检查患者和提供者的行为和经历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护理过程的影响；以及3)开发健康门户模式并传播健康门户技术和从AIMS 1和2的调查结果中获得的知识。作为健康门户方法的结果，我们预计活跃的患者和转变后的医疗实践将更有可能从事以患者为中心的主动性护理，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.