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Randomized Controlled Trial of Health Maintenance Reminders Provided Directly to Patients Through an Electronic PHR

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Abstract

BACKGROUND

Provider and patient reminders can be effective in increasing rates of preventive screenings and vaccinations. However, the effect of patient-directed electronic reminders is understudied.

OBJECTIVE

To determine whether providing reminders directly to patients via an electronic Personal Health Record (PHR) improved adherence to care recommendations.

DESIGN

We conducted a cluster randomized trial without blinding from 2005 to 2007 at 11 primary care practices in the Partners HealthCare system.

PARTICIPANTS

A total of 21,533 patients with access to a PHR were invited to the study, and 3,979 (18.5%) consented to enroll.

INTERVENTIONS

Patients in the intervention arm received health maintenance (HM) reminders via a secure PHR “eJournal,” which allowed them to review and update HM and family history information. Patients in the active control arm received access to an eJournal that allowed them to input and review information related to medications, allergies and diabetes management.

MAIN MEASURES

The primary outcome measure was adherence to guideline-based care recommendations.

KEY RESULTS

Intention-to-treat analysis showed that patients in the intervention arm were significantly more likely to receive mammography (48.6% vs 29.5%, p = 0.006) and influenza vaccinations (22.0% vs 14.0%, p = 0.018). No significant improvement was observed in rates of other screenings. Although Pap smear completion rates were higher in the intervention arm (41.0% vs 10.4%, p < 0.001), this finding was no longer significant after excluding women’s health clinics. Additional on-treatment analysis showed significant increases in mammography (p = 0.019) and influenza vaccination (p = 0.015) for intervention arm patients who opened an eJournal compared to control arm patients, but no differences for any measure among patients who did not open an eJournal.

CONCLUSIONS

Providing patients with HM reminders via a PHR may be effective in improving some elements of preventive care.

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References

  1. McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. N Engl J Med. 2003;348(26):2635–45.

    Article  PubMed  Google Scholar 

  2. 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):635–41.

    Article  PubMed  Google Scholar 

  3. IOM. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001.

  4. Shea S, DuMouchel W, Bahamonde L. A meta-analysis of 16 randomized controlled trials to evaluate computer-based clinical reminder systems for preventive care in the ambulatory setting. J Am Med Inform Assoc. 1996;3(6):399–409.

    Article  PubMed  CAS  Google Scholar 

  5. Tierney WM, Overhage JM, Murray MD, et al. Effects of computerized guidelines for managing heart disease in primary care. J Gen Intern Med. 2003;18(12):967–76.

    Article  PubMed  Google Scholar 

  6. Sequist TD, Gandhi TK, Karson AS, et al. A randomized trial of electronic clinical reminders to improve quality of care for diabetes and coronary artery disease. J Am Med Inform Assoc. 2005;12(4):431–7.

    Article  PubMed  Google Scholar 

  7. Shojania KG, Jennings A, Mayhew A, Ramsay CR, Eccles MP, Grimshaw J. The effects of on-screen, point of care computer reminders on processes and outcomes of care. Cochrane Database Syst Rev. 2009(3):CD001096.

  8. Blumenthal D, Tavenner M. The Meaningful Use Regulation for Electronic Health Records. N Engl J Med. 2010;363(6):501–4.

  9. Taplin SH, Anderman C, Grothaus L, Curry S, Montano D. Using physician correspondence and postcard reminders to promote mammography use. Am J Public Health. 1994;84(4):571–4.

    Article  PubMed  CAS  Google Scholar 

  10. King ES, Rimer BK, Seay J, Balshem A, Engstrom PF. Promoting mammography use through progressive interventions: is it effective? Am J Public Health. 1994;84(1):104–6.

    Article  PubMed  CAS  Google Scholar 

  11. Thomas RE, Russell M, Lorenzetti D. Interventions to increase influenza vaccination rates of those 60 years and older in the community. Cochrane Database Syst Rev. 2010(9):CD005188.

  12. Szilagyi PG, Bordley C, Vann JC, et al. Effect of patient reminder/recall interventions on immunization rates: A review. Jama. 2000;284(14):1820–7.

    Article  PubMed  CAS  Google Scholar 

  13. 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):121–6.

    Article  PubMed  CAS  Google Scholar 

  14. Poon EG, Wald J, Bates DW, Middleton B, Kuperman GJ, Gandhi TK. Supporting patient care beyond the clinical encounter: three informatics innovations from partners health care. AMIA Annu Symp Proc. 2003:1072.

  15. Wald J, Businger A, Gandhi T, et al. Implementing practice-linked pre-visit electronic journals in primary care: patient and physician use and satisfaction. J Am Med Inform Assoc. 2010.

  16. Grant RW, Wald JS, Poon EG, et al. Design and implementation of a web-based patient portal linked to an ambulatory care electronic health record: patient gateway for diabetes collaborative care. Diabetes Technol Ther. 2006;8(5):576–86.

    Article  PubMed  Google Scholar 

  17. Grant RW, Wald JS, Schnipper JL, et al. Practice-linked online personal health records for type 2 diabetes mellitus: a randomized controlled trial. Arch Intern Med. 2008;168(16):1776–82.

    Article  PubMed  Google Scholar 

  18. Schnipper JL, Gandhi TK, Wald JS, et al. Design and implementation of a web-based patient portal linked to an electronic health record designed to improve medication safety: the Patient Gateway medications module. Inform Prim Care. 2008;16(2):147–55.

    PubMed  Google Scholar 

  19. Siteman E, Businger A, Gandhi T, et al. Physicians value patient review of their electronic health record data as a means to improve accuracy of medication list documentation. AMIA Annu Symp Proc. 2007:1116.

  20. Wald JS, Grant RW, Schnipper JL, et al. Survey analysis of patient experience using a practice-linked PHR for type 2 diabetes mellitus. AMIA Annu Symp Proc. 2009;2009:678–82.

    PubMed  Google Scholar 

  21. Aljasem LI, Peyrot M, Wissow L, Rubin RR. The impact of barriers and self-efficacy on self-care behaviors in type 2 diabetes. Diabetes Educ. 2001;27(3):393–404.

    Article  PubMed  CAS  Google Scholar 

  22. Marks R, Allegrante JP, Lorig K. A review and synthesis of research evidence for self-efficacy-enhancing interventions for reducing chronic disability: implications for health education practice (part II). Health Promot Pract. 2005;6(2):148–56.

    Article  PubMed  Google Scholar 

  23. Holloway A, Watson HE. Role of self-efficacy and behaviour change. Int J Nurs Pract. 2002;8(2):106–15.

    Article  PubMed  Google Scholar 

  24. Simon SR, Kaushal R, Cleary PD, et al. Correlates of electronic health record adoption in office practices: a statewide survey. J Am Med Inform Assoc. 2007;14(1):110–7.

    Article  PubMed  Google Scholar 

  25. Ash JS, Sittig DF, Campbell EM, Guappone KP, Dykstra RH. Some unintended consequences of clinical decision support systems. AMIA Annu Symp Proc. 2007:26–30.

  26. Roblin DW, Houston TK 2nd, Allison JJ, Joski PJ, Becker ER. Disparities in use of a personal health record in a managed care organization. J Am Med Inform Assoc. 2009;16(5):683–9.

    Article  PubMed  Google Scholar 

  27. Kim EH, Kim Y. Digital divide: Use of electronic personal health record by different population groups. Conf Proc IEEE Eng Med Biol Soc. 2010;1:1759–62.

    Google Scholar 

  28. Kim EH, Stolyar A, Lober WB, et al. Challenges to using an electronic personal health record by a low-income elderly population. J Med Internet Res. 2009;11(4):e44.

    Article  PubMed  Google Scholar 

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Acknowledgements

This work was partially supported by AHRQ Grant R01-HS013660-02: Shared Online Health Records for Patient Safety and Quality. AHRQ was not involved in the design, execution or analysis of the study, or in the preparation of this manuscript. The study protocol was approved by the Partners HealthCare Human Research Committee and registered at ClinicalTrials.gov (NCT00251875).

Conflicts of Interest

None disclosed.

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Correspondence to Adam Wright PhD.

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Wright, A., Poon, E.G., Wald, J. et al. Randomized Controlled Trial of Health Maintenance Reminders Provided Directly to Patients Through an Electronic PHR. J GEN INTERN MED 27, 85–92 (2012). https://doi.org/10.1007/s11606-011-1859-6

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  • DOI: https://doi.org/10.1007/s11606-011-1859-6

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