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

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• 作者：Adam Wright PhD (1) (2) (3)
  Eric G. Poon MD ; MPH (1) (2) (3)
  Jonathan Wald MD ; MPH (1) (2) (3)
  Joshua Feblowitz MS (1) (2)
  Justine E. Pang (1) (2)
  Jeffrey L. Schnipper MD ; MPH (1) (2)
  Richard W. Grant MD ; MPH (3) (4)
  Tejal K. Gandhi MD ; MPH (1) (2) (3)
  Lynn A. Volk MHS (2)
  Amy Bloom MPH (2)
  Deborah H. Williams MHA (1)
  Kate Gardner (2)
  Marianna Epstein (2)
  Lisa Nelson (2)
  Alex Businger (1) (2)
  Qi Li MD ; MBA (2)
  David W. Bates MD ; MSc (1) (2) (3)
  Blackford Middleton MD ; MPH ; MSc (1) (2) (3)
  
• 关键词：health maintenance reminders ; personal health record ; preventive care ; clinical decision support ; Patient Gateway
• 刊名：Journal of General Internal Medicine
• 出版年：2012
• 出版时间：January 2012
• 年：2012
• 卷：27
• 期：1
• 页码：85-92
• 全文大小：475KB
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• 作者单位：Adam Wright PhD (1) (2) (3)
  Eric G. Poon MD, MPH (1) (2) (3)
  Jonathan Wald MD, MPH (1) (2) (3)
  Joshua Feblowitz MS (1) (2)
  Justine E. Pang (1) (2)
  Jeffrey L. Schnipper MD, MPH (1) (2)
  Richard W. Grant MD, MPH (3) (4)
  Tejal K. Gandhi MD, MPH (1) (2) (3)
  Lynn A. Volk MHS (2)
  Amy Bloom MPH (2)
  Deborah H. Williams MHA (1)
  Kate Gardner (2)
  Marianna Epstein (2)
  Lisa Nelson (2)
  Alex Businger (1) (2)
  Qi Li MD, MBA (2)
  David W. Bates MD, MSc (1) (2) (3)
  Blackford Middleton MD, MPH, MSc (1) (2) (3)
  
  1. Brigham & Women’s Hospital, 1620 Tremont St, Boston, MA, 02115, USA
  2. Partners HealthCare, Boston, MA, USA
  3. Harvard Medical School, Boston, MA, USA
  4. Massachusetts General Hospital, Boston, MA, USA
  

文摘

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--.006) and influenza vaccinations (22.0% vs 14.0%, p--.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-lt;-.001), this finding was no longer significant after excluding women’s health clinics. Additional on-treatment analysis showed significant increases in mammography (p--.019) and influenza vaccination (p--.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.