An Interactive Preventive Health Record (IPHR) to Promote Patient-Centered Preventive Care

Study Overview
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Brief Summary
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Americans only receive 50% of indicated preventive services. We hypothesize that an interactive preventive health record (IPHR) will increase the delivery of recommended screening tests, immunizations, and counseling. The IPHR will function as a highly sophisticated personal health record for prevention, linking patients directly to their health information in the electronic record of their primary care physician. The functions of the IPHR will extend beyond those of personal health records by providing tailored recommendations, links to educational resources and decision aids, and patient and clinician reminders. Year one will focus on updating and refining an existing IPHR prototype. The second and third year, through a randomized controlled trial, will examine the effectiveness of the IPHR. Outcomes will include (1) whether the IPHR increases the delivery of recommended preventive services, (2) whether participants use the IPHR, and (3) whether the IPHR increases shared decision-making and improves clinician-patient communication. The study will take place in seven primary care practices in the Virginia Ambulatory Care Outcomes Network (ACORN) that utilize a common electronic medical record (EMR). A randomly selected sample of 5,500 of the practices' 228,000 patients, stratified by age and gender, will be assigned in a one-to-one ratio to receive a request from their clinician to use the IPHR (intervention group) or receive usual preventive care (control group). A Preventive Services Survey, which uses standardized questions to evaluate the delivery of preventive care, will be mailed to 4,500 patients and the CAHPS Clinician & Group Survey will be mailed to 1,000 patients. Surveys will be mailed pre-intervention, 6 month post-intervention, and 18 months post-intervention. Delivery of preventive care will be measured by the Preventive Services Survey and EMR data, while shared decision-making and clinician-patient communication will be measured by the CAHPS survey. The change from baseline to 6 and 18 months post-intervention for the control and intervention groups will be compared.

Official Title
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An Interactive Preventive Health Record (IPHR) to Promote Patient-Centered Preventive Care

Conditions
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Prevention

Intervention / Treatment
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* Behavioral: Interactive Preventive Health Record (IPHR)
* Behavioral: Standard preventive care


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All adult patients seen in the study practices within the previous year Exclusion Criteria: Age <18 years Age >75 years

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention<br>Patients referred to the IPHR | Behavioral: Interactive Preventive Health Record (IPHR)<br>* Preventive health record designed to a) show patients the status of their preventive care recorded in their electronic record and b) make recommendations on what USPSTF endorsed preventive services that the user needs to receive.<br>|
| Active Comparator: Control<br>Patients receiving standard preventive care | Behavioral: Standard preventive care<br>* Existing mechanisim for receiving preventive care in primary care (i.e. patients not referred to the IPHR).<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The proportion of control and intervention subjects who are current on EACH individual indicated preventive service |  | Annual for three years | 
| The proportion of control and intervention subjects who are current on ALL indicated preventive services |  | Annual for three years | 
| The mean score for intervention and control subjects for quality of clinician communication (CAPHS-CGS questions 14-20); and frequency with which patients report sharing medical decisions (CAHPS questions SD 1-3) |  | Annual for three years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The proportion of intervention subjects who visit the IPHR and establish an account |  | During enrollment period | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Preventive Care, Health information technology, Personal health record