Interactive Preventive Health Record to Enhance Delivery of Recommended Care: A Randomized Trial

• Published in: Annals of family medicine Vol. 10; no. 4; pp. 312 - 319
• Main Authors: Krist, Alex H., MD, MPH, Woolf, Steven H., MD, MPH, Rothemich, Stephen F., MD, MS, Johnson, Robert E., PhD, Peek, J. Eric, BA, Cunningham, Tina D., PhD, Longo, Daniel R., ScD, Bello, Ghalib A., BS, Matzke, Gary R., PharmD
• Format: Journal Article
• Language: English
• Published: United States American Academy of Family Physicians 01.07.2012
• Subjects: Adolescent; Adult; Aged; Electronic Health Records; Female; Health Care Surveys; Humans; Internal Medicine; Male; Middle Aged; Motivation; Original Research; Patient-Centered Care - methods; Preventive Medicine - methods; Preventive Medicine - statistics & numerical data; Primary Health Care - methods; Primary Health Care - statistics & numerical data; Program Development - methods; Program Evaluation; Risk Assessment; Statistics as Topic; Virginia; Young Adult; Virginia; primary health care; health promotion; informatics; information management; patient-centered care
• ISSN: 1544-1709; 1544-1717
• DOI: 10.1370/afm.1383

Abstract Purpose Americans receive only one-half of recommended preventive services. Information technologies have been advocated to engage patients. We tested the effectiveness of an interactive preventive health record (IPHR) that links patients to their clinician's record, explains information in lay language, displays tailored recommendations and educational resources, and generates reminders. Methods This randomized controlled trial involved 8 primary care practices. Four thousand five hundred patients were randomly selected to receive a mailed invitation to use the IPHR or usual care. Outcomes were measured using patient surveys and electronic medical record data and included IPHR use and service delivery. Comparisons were made between invited and usual-care patients and between users and nonusers among those invited to use the IPHR. Results At 4 and 16 months, 229 (10.2%) and 378 (16.8%) of invited patients used the IPHR. The proportion of patients up-to-date with all services increased between baseline and 16 months by 3.8% among intervention patients (from 11.4% to 15.2%, P <.001) and by 1.5% among control patients (from 11.1% to 12.6%, P = .07), a difference of 2.3% ( P = .05). Greater increases were observed among patients who used the IPHR. At 16 months, 25.1% of users were up-to-date with all services, double the rate among nonusers. At 4 months, delivery of colorectal, breast, and cervical cancer screening increased by 19%, 15%, and 13%, respectively, among users. Conclusions Information systems that feature patient-centered functionality, such as the IPHR, have potential to increase preventive service delivery. Engaging more patients to use systems could have important public health benefits.