TY - JOUR
T1 - MyPreventiveCare
T2 - implementation and dissemination of an interactive preventive health record in three practice-based research networks serving disadvantaged patients--a randomized cluster trial
AU - Krist, Alex H.
AU - Aycock, Rebecca A.
AU - Etz, Rebecca S.
AU - Devoe, Jennifer E.
AU - Sabo, Roy T.
AU - Williams, Robert
AU - Stein, Karen L.
AU - Iwamoto, Gary
AU - Puro, Jon
AU - Deshazo, Jon
AU - Kashiri, Paulette L.ail
AU - Arkind, Jill
AU - Romney, Crystal
AU - Kano, Miria
AU - Nelson, Christine
AU - Longo, Daniel R.
AU - Wolver, Susan
AU - Woolf, Steven H.
N1 - Funding Information:
Funding for this study is provided by the National Cancer Institute (R01CA166375-01A1) and the National Center for Advancing Translational Sciences (UL1TR000058). The opinions expressed in this manuscript are those of the authors and do not necessarily reflect those of the funders. For more information on the IPHR including implementation please visit: http://healthit.ahrq.gov/sites/default/files/docs/page/PreventiveCare Handbook_062912comp.pdf.
PY - 2014
Y1 - 2014
N2 - BACKGROUND: Evidence-based preventive services for early detection of cancer and other health conditions offer profound health benefits, yet Americans receive only half of indicated services. Policy initiatives promote the adoption of information technologies to engage patients in care. We developed a theory-driven interactive preventive health record (IPHR) to engage patients in health promotion. The model defines five levels of 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. It is hypothesized that personal health records (PHRs) with these higher levels of functionality will inform and activate patients in ways that simpler PHRs cannot. However, realizing this vision requires both technological advances and effective implementation based upon clinician and practice engagement.METHODS/DESIGN: We are starting a two-phase, mixed-method trial to evaluate whether the IPHR is scalable across a large number of practices and how its uptake differs for minority and disadvantaged patients. In phase 1, 40 practices from three practice-based research networks will be randomized to add IPHR functionality to their PHR versus continue to use their existing PHR. Throughout the study, we will engage intervention practices to locally tailor IPHR content and learn how to integrate new functions into their practice workflow. In phase 2, the IPHR to all nonintervention practices to observe whether the IPHR can be implemented more broadly (Scalability). 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 incremental effect of the IPHR on receipt of cancer screening tests and shared decision-making compared to traditional PHRs will assess Effectiveness. In phase 2, we will assess similar outcomes as phase 1 except for effectiveness.DISCUSSION: This study will yield information about the effectiveness of new health information technologies designed to actively engage patients in their care as well as information about how to effectively implement and disseminate PHRs by engaging clinicians.TRIAL REGISTRATION: ClinicalTrials.gov: NCT02138448.
AB - BACKGROUND: Evidence-based preventive services for early detection of cancer and other health conditions offer profound health benefits, yet Americans receive only half of indicated services. Policy initiatives promote the adoption of information technologies to engage patients in care. We developed a theory-driven interactive preventive health record (IPHR) to engage patients in health promotion. The model defines five levels of 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. It is hypothesized that personal health records (PHRs) with these higher levels of functionality will inform and activate patients in ways that simpler PHRs cannot. However, realizing this vision requires both technological advances and effective implementation based upon clinician and practice engagement.METHODS/DESIGN: We are starting a two-phase, mixed-method trial to evaluate whether the IPHR is scalable across a large number of practices and how its uptake differs for minority and disadvantaged patients. In phase 1, 40 practices from three practice-based research networks will be randomized to add IPHR functionality to their PHR versus continue to use their existing PHR. Throughout the study, we will engage intervention practices to locally tailor IPHR content and learn how to integrate new functions into their practice workflow. In phase 2, the IPHR to all nonintervention practices to observe whether the IPHR can be implemented more broadly (Scalability). 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 incremental effect of the IPHR on receipt of cancer screening tests and shared decision-making compared to traditional PHRs will assess Effectiveness. In phase 2, we will assess similar outcomes as phase 1 except for effectiveness.DISCUSSION: This study will yield information about the effectiveness of new health information technologies designed to actively engage patients in their care as well as information about how to effectively implement and disseminate PHRs by engaging clinicians.TRIAL REGISTRATION: ClinicalTrials.gov: NCT02138448.
UR - http://www.scopus.com/inward/record.url?scp=84965188684&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84965188684&partnerID=8YFLogxK
U2 - 10.1186/s13012-014-0181-1
DO - 10.1186/s13012-014-0181-1
M3 - Article
C2 - 25500097
AN - SCOPUS:84965188684
SN - 1748-5908
VL - 9
SP - 181
JO - Implementation science : IS
JF - Implementation science : IS
ER -