Population-Based Patient-Centric Care: Comprehensive Preventive Cancer Screening Using Health IT
Condition: Breast Cancer; Colorectal Cancer; Cervical Cancer
MeSH terms: Colorectal Neoplasms; Uterine Cervical Neoplasms
Study type: Interventional

Summary: 
      Although there is considerable evidence that current health IT can improve certain elements
      of care, the most effective and efficient implementation of health IT systems for primary
      care population management are not currently known. Indeed, while many systems currently take
      a "case-management" approach to identify and address clinical care issues for high risk
      patients, no systems to our knowledge apply a risk-based approach that accounts both for
      adverse clinical outcome risk (e.g. breast cancer in a woman who has not had indicated
      screening for 4 years) and for clinical process risk (e.g. the likelihood that a specific
      patient will ignore a reminder letter and would therefore benefit from direct phone or in
      person contact). The investigators propose to directly test the hypothesis that implementing
      a health IT platform that 1) provides novel risk-based decision support using data derived
      from the electronic health record (EHR) and 2) leverages each clinician's unique knowledge of
      his or her patient panel will result in more effective and more efficient population-based
      primary care. The investigators will test this hypothesis in a practice-randomized clinical
      trial of preventive cancer screening within our primary care Practice-Based Research Network
      (PBRN).
    

Detailed description: 
      In prior NIH-funded research, the investigators have demonstrated the efficacy of an IT-based
      population management system to improve breast cancer screening (NCI R21 CA121908). The
      investigators will expand our current IT platform from this single function (breast cancer
      screening) to a package of cancer prevention actions (breast, cervical, and colorectal cancer
      screening) and examine the added benefit of population-level preventive cancer care that is
      directed by specific clinician knowledge of individual patient needs. Moreover, rather than
      compare our system to currently sub-optimal "usual care" practice, our goal is to test
      whether the impact of our intervention exceeds the current state-of-the-art of IT-based
      population management. Therefore, control group practices will receive augmented standard
      care defined as a population-level reminder system with automated patient contacts.

      In augmented standard care control practices, the investigators will implement a system that
      includes: 1) a population-based perspective to identify all eligible patients overdue for
      screening, 2) an automated, centralized process to contact selected patients by letter, 3) a
      result management system that automatically tracks test scheduling and completion, 4) a
      web-based, easily accessible tool allowing practice personnel to contact patients not
      completing testing, and 5) use of patient navigators for high risk patients not responding to
      initial outreach. In the control arm, the process of escalating the reminder intervention
      from a letter, to contact by phone call, to a patient navigator, will occur in a standard
      algorithmic fashion without provider input. While not yet the standard of care nationwide,
      prior studies have proven the efficacy of such an approach. In intervention practices, the
      investigators will enhance augmented standard care by implementing a novel system that will
      enable physicians and clinical population managers to individualize care for each patient in
      their panel using tools to classify and organize patients by their clinical attributes. The
      investigators hypothesize that this personalized identification of patients by both their
      clinical outcome and clinical process risk status will improve the efficacy and efficiency of
      resource allocation decisions. The key additions to the health IT system for intervention
      practices will be: 1) a clinical systems IT platform to organize and present clinical data
      for each clinician's patient panel, 2) an accessible Web-based tool allowing clinicians
      (physicians and clinical population managers) to view, organize, and investigate their
      patient panels, and 3) a simple process where the clinician can make a tailored screening
      decision and designate the method of clinical intervention based upon the patient's risk
      profile.
    

Intervention name(s): TopCare: Use of provider knowledge vs. automated system
Intervention type(s): Other
Intervention description(s): We will be evaluating the system in practices where providers are involved in determining to contact a patient, including the most appropriate outreach method, compared with practices where the system is fully automated without provider input.
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: medical informatics; health IT; primary care; screening; cervical cancer; colorectal cancer; breast cancer; mammography; colonoscopy; pap smear