Implementing Personal Health Records to Promote Evidence-Based Cancer Screening
Condition: Cancer; Health Promotion
Study type: Interventional

Summary: 
      Cancer screening can improve the length and quality of life, yet the average American
      receives only half of recommended services. Patient-centered personal health records with
      higher levels of functionality, combined with practice redesign to make use of these
      functions, can help patients obtain recommended cancer screening tests by linking them to
      their doctor's records, explaining information in lay language, displaying tailored
      recommendations and educational resources, providing logistical support and tools to
      stimulate action, and generating reminders. This project will measure whether making these
      resources available to primary care practices and patients promotes shared decision-making
      and increases the delivery of cancer screening compared to existing information systems.
    

Detailed description: 
      We developed a theory-driven interactive Patient Health Record (PHR) that uses higher
      functionality to more deeply engage patients in health promotion. The model defines five
      levels of PHR 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. We hypothesize that implementing PHRs with these higher levels of
      functionality will inform and activate patients in ways that simpler PHRs cannot achieve and
      will increase uptake of preventive services. In Phase 1, we will randomize 46 practices from
      three practice-based research networks in eight states to implement a PHR with advanced
      versus simpler functionality. Control practices will use their existing PHR. Intervention
      practices will upgrade their PHR to feature an interactive preventive health record (IPHR)
      that we have previously developed and tested. Intervention practices will locally tailor the
      IPHR content and learn how to integrate new functions into practice. 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 randomized comparison of intervention and control practices will measure
      the incremental effect of the IPHR on shared decision-making and receipt of cancer screening
      tests compared to traditional PHRs (Effectiveness). Data sources will include the
      EHR/PHR/IPHR databases, patient and practice surveys, recruitment field notes, practice
      learning collaborative transcripts, practice diaries, and patient phone interviews. This
      study will inform future efforts to use patient-centered information technology to promote
      cancer prevention and the feasibility of national dissemination.
    

Intervention name(s): Interactive Preventive Health Record
Intervention type(s): Behavioral
Intervention description(s): The interactive preventive healthcare record (IPHR) is a patient-centered application that links patients to their clinician's record, explains information in lay language, displays tailored recommendations and educational resources, and makes preventive care actionable.
Other intervention name(s): MyPreventiveCare
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Cancer Screenings; Health Information Technology; Patient Health Record; Preventive Services