MyPreventiveCare: implementation and dissemination of an interactive preventive health record in three practice-based research networks serving disadvantaged patients--a randomized cluster trial

Alex H Krist, Rebecca A Aycock, Rebecca S Etz, Jennifer E Devoe, Roy T Sabo, Robert Williams, Karen L Stein, Gary Iwamoto, Jon Puro, Jon Deshazo, Paulette Lail Kashiri, Jill Arkind, Crystal Romney, Miria Kano, Christine Nelson, Daniel R Longo, Susan Wolver, Steven H Woolf, Alex H Krist, Rebecca A Aycock, Rebecca S Etz, Jennifer E Devoe, Roy T Sabo, Robert Williams, Karen L Stein, Gary Iwamoto, Jon Puro, Jon Deshazo, Paulette Lail Kashiri, Jill Arkind, Crystal Romney, Miria Kano, Christine Nelson, Daniel R Longo, Susan Wolver, Steven H Woolf

Abstract

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.

Figures

Figure 1
Figure 1
Study CONSORT flow diagram.
Figure 2
Figure 2
Engagement of stakeholders.
Figure 3
Figure 3
Study timeline.

References

    1. McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J, DeCristofaro A, Kerr EA. The quality of health care delivered to adults in the United States. N Engl J Med. 2003;348(26):2635–2645. doi: 10.1056/NEJMsa022615.
    1. Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010;60(5):277–300. doi: 10.3322/caac.20073.
    1. U.S. Cancer Statistics Working Group: United States Cancer Statistics: 1999–2007 incidence and mortality web-based report. 2010. . Accessed Aug 2010.
    1. Cancer topics. 2011. . Accessed Aug, 2011.
    1. Behavioral Risk Factor Surveillance System: Prevalence data. 2010. . Accessed Aug, 2011.
    1. Bolen J, Adams M, Shenson D. Routine preventive services for older women: a composite measure highlights gaps in delivery. J Womens Health (Larchmt) 2007;16(5):583–593. doi: 10.1089/jwh.2007.CDC5.
    1. U.S. Department of Health and Human Services . Healthy People 2010: Understanding and Improving Health. 2. Washington, D.C: Government Printing Office; 2000.
    1. Kottke TE, Brekke ML, Solberg LI. Making “time” for preventive services. Mayo Clin Proc Aug. 1993;68(8):785–791. doi: 10.1016/S0025-6196(12)60638-7.
    1. Jaen CR, Stange KC, Nutting PA. Competing demands of primary care: a model for the delivery of clinical preventive services. J Fam Pract. 1994;38(2):166–171.
    1. Woolf SH, Krist AH, Rothemich SF. Joining Hands: Partnerships Between Physicians and the Community in the Delivery of Preventive Care. Washington D.C.: Center for American Progress; 2006.
    1. Yarnall KS, Pollak KI, Ostbye T, Krause KM, Michener JL. Primary care: is there enough time for prevention? Am J Public Health. 2003;93(4):635–641. doi: 10.2105/AJPH.93.4.635.
    1. Sheridan SL, Harris RP, Woolf SH. Shared decision making about screening and chemoprevention. A suggested approach from the U.S. Preventive Services Task Force. Am J Prev Med. 2004;26(1):56–66. doi: 10.1016/j.amepre.2003.09.011.
    1. Braddock CH, 3rd, Edwards KA, Hasenberg NM, Laidley TL, Levinson W. Informed decision making in outpatient practice: time to get back to basics. Jama. 1999;282(24):2313–2320. doi: 10.1001/jama.282.24.2313.
    1. Edwards A, Elwyn G. Evidence-based patient choice. Oxford, Great Britian: Oxford University Press; 2001.
    1. Breast cancer risk assessment tool. 2004. , 2004.
    1. Prevention and care management. 2011. .
    1. Smith RA, Cokkinides V, Brawley OW. Cancer screening in the United States, 2009: a review of current American cancer society guidelines and issues in cancer screening. CA Cancer J Clin. 2009;59(1):27–41. doi: 10.3322/caac.20008.
    1. Squiers LB, Holden DJ, Dolina SE, Kim AE, Bann CM, Renaud JM. The public’s response to the U.S. Preventive Services Task Force’s 2009 recommendations on mammography screening. Am J Prev Med. 2011;40(5):497–504. doi: 10.1016/j.amepre.2010.12.027.
    1. Levin B, Lieberman DA, McFarland B, Andrews KS, Brooks D, Dash C, Giardiello FM, Glick S, Levin TR, Pickhardt PJ, Rex DK, Smith RA, Thorson A, Bond J, Johnson D, Johnson CD, Winawer SJ. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. 2008.
    1. Levin B, Smith RA, Feldman GE, Colditz GA, Fletcher RH, Nadel M, Rothenberger DA, Schroy PS, 3rd, Vernon SW, Wender R. Promoting early detection tests for colorectal carcinoma and adenomatous polyps: a framework for action: the strategic plan of the National Colorectal Cancer Roundtable. Cancer. 2002;95(8):1618–1628. doi: 10.1002/cncr.10890.
    1. Petitti DB, Teutsch SM, Barton MB, Sawaya GF, Ockene JK, DeWitt T. Update on the methods of the U.S. Preventive Services Task Force: insufficient evidence. Ann Intern Med. 2009;150(3):199–205. doi: 10.7326/0003-4819-150-3-200902030-00010.
    1. Guyatt GH, Helfand M, Kunz R. Comparing the USPSTF and GRADE approaches to recommendations. Ann Intern Med. 2009;151(5):363. doi: 10.7326/0003-4819-151-5-200909010-00016.
    1. Schwartz LM, Woloshin S, Fowler FJ, Jr, Welch HG. Enthusiasm for cancer screening in the United States. JAMA. 2004;291(1):71–78. doi: 10.1001/jama.291.1.71.
    1. Taplin SH, Rollason D, Camp A, di Donato K, Maggenheimer E: Imagining an electronic medical record for turning cancer screening knowledge into J Prev Med38(1):89–97,
    1. Tang PC, Ash JS, Bates DW, Overhage JM, Sands DZ. Personal health records: definitions, benefits, and strategies for overcoming barriers to adoption. J Am Med Inform Assoc. 2006;13(2):121–126. doi: 10.1197/jamia.M2025.
    1. Tang PC, Lee TH. Your doctor’s office or the Internet? Two paths to personal health records. N Engl J Med. 2009;360(13):1276–1278. doi: 10.1056/NEJMp0810264.
    1. Krist AH, Woolf SH. A vision for patient-centered health information systems. JAMA. 2011;305(3):300–301. doi: 10.1001/jama.2010.2011.
    1. Chaudhry B, Wang J, Wu S, Maglione M, Mojica W, Roth E, Morton SC, Shekelle PG. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Ann Intern Med. 2006;144(10):742–752. doi: 10.7326/0003-4819-144-10-200605160-00125.
    1. Zickuhr K, Smith A. Digital differences. 2012.
    1. Turner-Lee N, Smedley BD, Miller J. Minorities, mobile broadband and the management of chronic diseases. Washington DC: Joint Center for Political and Economic Studies; 2012.
    1. Connecting for Health: Americans overwhelmingly believe electronic personal health records could improve their health. 2008. . Accessed May, 2009.
    1. Krist AH, Peele E, Woolf SH, Rothemich SF, Loomis JF, Longo DR, Kuzel AJ. Designing a patient-centered personal health record to promote preventive care. BMC Med Inform Decis Mak. 2011;11:73. doi: 10.1186/1472-6947-11-73.
    1. Krist AH: Featured projects. Patients take a bite of prevention apple with web-based interactive personal health records. 2011. . Accessed Aug, 2011.
    1. Krist AH, Woolf SH, Rothemich SF, Johnson RE, Peele E, Cunningham T, Longo DR, Bello G, Matzke GR. Randomized trial of an interactive preventive health record to enhance the delivery of recommended care. Ann Fam Med. 2012;10(4):312–319. doi: 10.1370/afm.1383.
    1. Preventive services. 2010. . Accessed July, 2010.
    1. . 2014. . Accessed February, 2014.
    1. Skinner CS, Campbell MK, Rimer BK, Curry S, Prochaska JO. How effective is tailored print communication? Ann Behav Med Fall. 1999;21(4):290–298. doi: 10.1007/BF02895960.
    1. Rimer BK. Improving the use of cancer screening for older women. Cancer. 1993;72(3 Suppl):1084–1087. doi: 10.1002/1097-0142(19930801)72:3+<1084::AID-CNCR2820721324>;2-F.
    1. Glanz K, Lewis FM, Rimer B. Health Behavior and Health Education. 2. San Francisco: Jossey-Bass; 1997.
    1. Mullen PD, Simons-Morton DG, Ramirez G, Frankowski RF, Green LW, Mains DA. A meta-analysis of trials evaluating patient education and counseling for three groups of preventive health behaviors. Patient Educ Couns. 1997;32(3):157–173. doi: 10.1016/S0738-3991(97)00037-2.
    1. Solberg LI, Brekke ML, Fazio CJ, Fowles J, Jacobsen DN, Kottke TE, Mosser G, O'Connor PJ, Ohnsorg KA, Rolnick SJ. Lessons from experienced guideline implementers: attend to many factors and use multiple strategies. Jt Comm J Qual Improv. 2000;26(4):171–188.
    1. Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness. JAMA. 2002;288(14):1775–1779. doi: 10.1001/jama.288.14.1775.
    1. Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness: the chronic care model, part 2. JAMA. 2002;288(15):1909–1914. doi: 10.1001/jama.288.15.1909.
    1. Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: translating evidence into action. Health Aff (Millwood) 2001;20(6):64–78. doi: 10.1377/hlthaff.20.6.64.
    1. Glasgow RE, Orleans CT, Wagner EH. Does the chronic care model serve also as a template for improving prevention? Milbank Q. 2001;79(4):579–612. doi: 10.1111/1468-0009.00222.
    1. Orleans CT, Schoenbach VJ, Wagner EH, Quade D, Salmon MA, Pearson DC, Fiedler J, Porter CQ, Kaplan BH. Self-help quit smoking interventions: effects of self-help materials, social support instructions, and telephone counseling. J Consult Clin Psychol. 1991;59(3):439–448. doi: 10.1037/0022-006X.59.3.439.
    1. Street RL, Gold WR, Manning TE. Health promotion and interactive technology: theoretical applications and future directions. London, England: Lawrence Wrlbaum Associates; 1997.
    1. Glasgow RE, McKay HG, Boles SM, Vogt TM. Interactive computer technology, behavioral science, and family practice. J Fam Pract. 1999;48(6):464–470.
    1. Krist AH, Woolf SH, Bello G, Sabo RT, Longo DR, Kashiri P, Etz RS, Loomis J, Rothemich SF, Peele JE, Cohn J. Engaging primary care patients to use a patient-centered personal health record. Ann Fam Med. 2014;12:418–426. doi: 10.1370/afm.1691.
    1. Department of Family Medicine: Virginia Commonwealth University. A How-To Guide for Using Patient-Centered Personal Health Records to Promote Prevention. 2012. . Accessed June, 2012.
    1. American EHR Partners: Market share and top 10 rated ambulatory EHR products by practice size. 2011. . Accessed June, 2012.
    1. Reach Effectiveness Adoption Implementation Maintenance (RE-AIM). 2011. . Accessed Sept, 2011.
    1. Glasgow RE, Klesges LM, Dzewaltowski DA, Estabrooks PA, Vogt TM. Evaluating the impact of health promotion programs: using the RE-AIM framework to form summary measures for decision making involving complex issues. Health Educ Res. 2006;21(5):688–694. doi: 10.1093/her/cyl081.
    1. Glasgow RE. RE-AIMing research for application: ways to improve evidence for family medicine. J Am Board Fam Med. 2006;19(1):11–19. doi: 10.3122/jabfm.19.1.11.
    1. Borkan JM. Mixed methods studies: a foundation for primary care research. Ann Fam Med. 2004;2(1):4–6. doi: 10.1370/afm.111.
    1. ACORN: Ambulatory Care Outcomes Research Network.. Accessed Sept, 2014.,
    1. Devoe JE, Gold R, Spofford M, Chauvie S, Muench J, Turner A, Likumahuwa S, Nelson C. Developing a network of community health centers with a common electronic health record: description of the Safety Net West Practice-based Research Network (SNW-PBRN) J Am Board Fam Med. 2011;24(5):597–604. doi: 10.3122/jabfm.2011.05.110052.
    1. DeVoe JE, Likumahuwa S, Eiff MP, Nelson CA, Carroll JE, Hill CN, Gold R, Kullberg PA. Lessons learned and challenges ahead: report from the OCHIN Safety Net West practice-based research network (PBRN) J Am Board Fam Med. 2012;25(5):560–564. doi: 10.3122/jabfm.2012.05.120141.
    1. Devoe JE, Sears A. The OCHIN community information network: bringing together community health centers, information technology, and data to support a patient-centered medical village. J Am Board Fam Med. 2013;26(3):271–278. doi: 10.3122/jabfm.2013.03.120234.
    1. Research Involving Outpatient Settings Network (RIOSnet).. Accessed Sept, 2014.,
    1. OCHIN.. Accessed Sept, 2014.,
    1. Glanz K, Rimer BK. Theory at a glance. A guide for health promotion practice. 2005.
    1. Porras JI, Robertson PJ. Organization development theory: a typology and evaluation. In: Woodman RW, Passmore WA, editors. Research in Organizational Change and Development. Greenwich, CN: JAI Press; 1987.
    1. Fischer LR, Solberg LI, Kottke TE. Quality improvement in primary care clinics. Jt Comm J Qual Improv. 1998;24(7):361–370.
    1. Solberg LI. Improving medical practice: a conceptual framework. Ann Fam Med. 2007;5(3):251–256. doi: 10.1370/afm.666.
    1. Koeck C. Time for organisational development in healthcare organisations. Improving quality for patients means changing the organisation. BMJ. 1998;317(7168):1267–1268. doi: 10.1136/bmj.317.7168.1267.
    1. Senge PM. The Fifth Discipline: The Art & Practice of the Learning Organization. New York, NY: Currency Doubleday; 1990.
    1. Kotter J: Winning at change. Leader to Leader, 10, 27–33. 1999. . Accessed May, 2009.
    1. Feifer C, Ornstein SM, Jenkins RG, Wessell A, Corley ST, Nemeth LS, Roylance L, Nietert PJ, Liszka H. The logic behind a multimethod intervention to improve adherence to clinical practice guidelines in a nationwide network of primary care practices. Eval Health Prof. 2006;29(1):65–88. doi: 10.1177/0163278705284443.
    1. Ovretveit J, Scott T, Rundall TG, Shortell SM, Brommels M. Implementation of electronic medical records in hospitals: two case studies. Health Policy. 2007;84(2–3):181–190. doi: 10.1016/j.healthpol.2007.05.013.
    1. Creswell JW, Fetters MD, Ivankova NV. Designing a mixed methods study in primary care. Ann Fam Med. 2004;2(1):7–12. doi: 10.1370/afm.104.
    1. Scott JT, Rundall TG, Vogt TM, Hsu J. Kaiser Permanente’s experience of implementing an electronic medical record: a qualitative study. BMJ. 2005;331(7528):1313–1316. doi: 10.1136/bmj.38638.497477.68.
    1. Plesk P. Redesigning health care with insights from the science of complex adaptive systems. In: Io M, editor. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001. pp. 322–335.
    1. Rogers EM. Diffusion of Innovations. 5. New York, NY: Free Press; 2003.
    1. Sussman S, Valente TW, Rohrbach LA, Skara S, Pentz MA. Translation in the health professions: converting science into action. Eval Health Prof. 2006;29(1):7–32. doi: 10.1177/0163278705284441.
    1. Etz RS, Cohen DJ, Woolf SH, Holtrop JS, Donahue KE, Isaacson NF, Stange KC, Ferrer RL, Olson AL. Bridging primary care practices and communities to promote healthy behaviors. Am J Prev Med. 2008;35(5 Suppl):S390–397. doi: 10.1016/j.amepre.2008.08.008.
    1. Cohen DJ, Leviton LC, Isaacson N, Tallia AF, Crabtree BF. Online diaries for qualitative evaluation: gaining real-time insights. Am J Eval. 2006;27:163–184. doi: 10.1177/1098214006288448.
    1. Tierney WM, Oppenheimer CC, Hudson BL, Benz J, Finn A, Hickner JM, Lanier D, Gaylin DS. A national survey of primary care practice-based research networks. Ann Fam Med. 2007;5(3):242–250. doi: 10.1370/afm.699.
    1. Wakefield DS, Halbesleben JR, Ward MM, Qiu Q, Brokel J, Crandall D. Development of a measure of clinical information systems expectations and experiences. Med Care. 2007;45(9):884–890. doi: 10.1097/MLR.0b013e3180653625.
    1. Ajami S, Bagheri-Tadi T. Barriers for Adopting Electronic Health Records (EHRs) by Physicians. Acta informatica medica: AIM: J Soc Med Informatics of Bosnia & Herzegovina: casopis Drustva za medicinsku informatiku BiH. 2013;21(2):129–134.
    1. Leykum LK, Palmer R, Lanham H, Jordan M, McDaniel RR, Noel PH, Parchman M. Reciprocal learning and chronic care model implementation in primary care: results from a new scale of learning in primary care. BMC Health Serv Res. 2011;11:44. doi: 10.1186/1472-6963-11-44.
    1. Patient centered medical home assessment (PCMH-A).. Accessed Sept, 2014.,
    1. Dillman D. Mail and Internet Surveys: The Total Design Method. 2. Hoboken NJ: John Wiley and Sons; 1999.
    1. Dillman DA. Mail and Internet Surveys: The Tailored Design Method. 2. Hoboken NJ: John Wiley Company; 1999.
    1. Edwards P, Roberts I, Clarke M, DiGuiseppi C, Pratap S, Wentz R, Kwan I. Increasing response rates to postal questionnaires: systematic review. BMJ. 2002;324(7347):1183. doi: 10.1136/bmj.324.7347.1183.
    1. Health Information National Trends Survey. 2007. . Accessed Sept, 2011.
    1. CAHPS Clinician & Group Survey. 2011. . Accessed Sept, 2011.
    1. O'Connor AM. Validation of a decisional conflict scale. Med Decis Making. 1995;15(1):25–30. doi: 10.1177/0272989X9501500105.
    1. O'Connor A. Decisional Conflict Scale. 4. Ottawa: University of Ottawa; 1999.
    1. Linder SK, Swank PR, Vernon SW, Mullen PD, Morgan RO, Volk RJ: Validity of a low literacy version of the Decisional Conflict Scale.Patient Educ Couns.,
    1. Degner LF, Sloan JA. Decision making during serious illness: what role do patients really want to play? J Clin Epidemiol. 1992;45(9):941–950. doi: 10.1016/0895-4356(92)90110-9.
    1. Degner LF, Sloan JA, Venkatesh P. The control preferences scale. Can J Nurs Res Fall. 1997;29(3):21–43.
    1. Measuring the use of the RE-AIM framework constructs checklist. 2011. . Accessed Sept, 2011.
    1. Krueger RA. Focus group: a practical guide for applied research. 3. Thousand Oaks, CA: Sage Publications; 2000.
    1. Krueger RA. Analyzing and Reporting Focus Groups Results, (Focus Group Kit, Vol #6) Thousand Oaks, CA: Sage Publications; 1997.
    1. Patton MQ. Qualitative Research and Evaluation Methods. Thousand Oaks, CA: Sage Publications; 2001.
    1. Miles MB, Huberman M. Qualitative Data Analysis: An Expanded Sourcebook. 2. Newbury Park, CA: Sage Publications; 1994.
    1. Devers KJ. How will we know “good” qualitative research when we see it? Beginning the dialogue in health services research. Health Serv Res. 1999;34(5 Pt 2):1153–1188.
    1. Richards L, Morse JM. README FIRST for a User's Guide to Qualitative Methods. 2. Thousand Oaks, CA: SAGE Publications, Inc; 2007.
    1. Crabtree BF, Miller WL. Doing Qualitative Research. 2. California: Sage Oaks; 1999.
    1. Ryan GW, Bernard HR. Techniques to identify themes. Field Methods. 2003;15:85–109. doi: 10.1177/1525822X02239569.
    1. Nolan T, Berwick DM. All-or-none measurement raises the bar on performance. JAMA. 2006;295(10):1168–1170. doi: 10.1001/jama.295.10.1168.

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