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Research ArticleOriginal Research

Interactive Preventive Health Record to Enhance Delivery of Recommended Care: A Randomized Trial

Alex H. Krist, Steven H. Woolf, Stephen F. Rothemich, Robert E. Johnson, J. Eric Peele, Tina D. Cunningham, Daniel R. Longo, Ghalib A. Bello and Gary R. Matzke
The Annals of Family Medicine July 2012, 10 (4) 312-319; DOI: https://doi.org/10.1370/afm.1383
Alex H. Krist
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  • For correspondence: ahkrist@vcu.edu
Steven H. Woolf
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Stephen F. Rothemich
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Robert E. Johnson
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J. Eric Peele
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Tina D. Cunningham
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Daniel R. Longo
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Ghalib A. Bello
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Gary R. Matzke
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    Figure 1

    New interactive preventive health record (IPHR) users based on invitations mailed to patients.

    Note: Number of patients who logged onto the IPHR, established an account, and received prevention recommendations. A total of 2,250 invitations were mailed (intervention population).

Tables

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    Table 1

    Characteristics of Intervention and Control Patients

    CharacteristicControl Population (n = 2,250)
    No. (%)
    Intervention Population (n = 2,250)
    No. (%)
    Intervention Population Subgroup Analysis
    Nonusers (n = 1,872)
    No. (%)
    Usersa (n = 378)
    No. (%)
    Age, years
     18–34446 (19.8)444 (19.7)413 (22.0)31 (8.2)
     35–49675 (30.0)677 (30.1)580 (31.0)97 (25.7)
     50–64676 (30.0)676 (30.0)524 (28.0)152 (40.2)
     65–75453 (20.1)453 (20.1)355 (19.0)98 (25.9)
    Sex
     Male1125 (50.01,126 (50.0)915 (48.9)211 (55.8)
     Female1125 (50.0)1,124 (50.0)957 (51.1)167 (44.2)
    Raceb
     White1,251 (79.6)1,206 (79.2)923 (78.1)283 (83.5)
     African American93 (6.0)100 (6.6)78 (6.6)22 (6.5)
     Asian149 (9.4)145 (9.5)120 (10.1)25 (7.4)
     Other63 (4.0)51 (3.4)42 (3.6)9 (2.6)
     Unknown16 (1.0)19 (1.3)19 (1.6)0 (0.0)
     Hispanic ethnicityb
     Hispanic95 (6.0)90 (5.9)81 (6.9)9 (2.7)
     Non-Hispanic1,477 (94.0)1,431 (94.1)1,101 (93.1)330 (97.3)
    Educationb
     College or higher777 (67.7)735 (64.5)540 (62.8)195 (69.9)
     Less than college371 (32.3)404 (35.5)320 (37.2)84 (30.1)
    Comorbidities
     Diabetes208 (9.2)192 (8.5)153 (8.2)39 (10.3)
     Cancer68 (3.0)75 (3.3)55 (2.9)20 (5.3)
     Coronary artery disease96 (4.3)98 (4.4)75 (4.0)23 (6.1)
     Hyperlipidemia733 (32.6)696 (30.9)544 (29.1)152 (40.2)
     Hypertension646 (28.7)634 (28.2)488 (26.1)146 (38.6)
    Use Internet at least once per dayb868 (75.6)839 (73.7)614 (71.4)225 (80.7)
    • ↵a There were statistically significant differences between users and nonusers for age (P <.001), sex (P=.02), ethnicity (P=.04), education (P = .03), percentage with cancer (P = .03), percentage with hyperlipidemia (P <.001), percentage with hypertension (P <.001), and Internet use (P=.002).

    • ↵b Only includes survey respondents, as data were not available in the electronic health record.

    • View popup
    Table 2

    Percentage of Up-to-Date Preventive Services at Baseline, 4 Months, and 16 Months Postintervention

    Control Population (n = 2,250)Intervention Population (n = 2,250)Intervention Population Subgroup Analysis
    Nonusers (n = 1,872)Users (n = 378)
    Indicated Preventive ServicesBaseline4 mo16 moBaseline4 mo16 moBaseline4 mo16 moBaseline4 mo16 mo
    Overall delivery of indicated preventive services
    Patients up-to-date on all indicated services (all-or-none measure)11.112.112.611.413.5a,b15.2b,c11.713.413.9b,d13.617.825.1b,c
    Percentage of up-to- date services (composite measure)61.462.159.2c,e61.763.1b,d60.460.961.558.5a,e64.970.1b,c69.4a,b
    Delivery of specific preventive services
    Colorectal cancer screening36.840.443.9b,d37.745.2a,b47.8b,c40.043.946.6a,b53.072.2a,b73.9b,c
    Breast cancer screening44.153.2b,d29.6c,e52.458.535.8c,e52.955.736.2c,e75.190.1b,d66.1
    Cervical cancer screening67.671.868.472.774.973.371.572.071.079.591.2a,b92.4a,b
    Prostate cancer screening56.846.5c,e48.9a,e50.848.552.347.046.252.071.865.062.0
    Hypertension screening99.998.1c,e93.0c,e100.098.6c,e92.8c,e99.994.5c,e79.9c,e100.099.596.6c,e
    Hypercholesterolemia screening82.886.0a,b85.9b,d80.783.2 b,d85.2b,c79.782.184.5b,c91.193.293.3
    Abdominal aortic aneurysm screening24.022.725.324.623.725.428.522.722.615.425.932.1
    Diabetes screening77.180.682.0a,b74.981.3a,b84.5b,c76.182.6a,b84.9b,c87.990.696.7a,b
    Chlamydia screening21.110.221.717.810.021.3––––––
    Osteoporosis screening39.741.948.545.251.157.9b,d38.241.051.7b,d72.090.696.3
    Aspirin chemoprophylaxis use53.158.958.861.056.857.661.856.755.558.357.164.8
    Tetanus immunization46.952.3a,b51.4a,b46.452.8b,c52.8b,c51.155.7a,b55.7a,b57.670.9a,b72.6b,c
    Influenza immunization30.728.627.529.630.330.629.228.829.637.342.140.7
    Pneumococcal immunization22.527.8a,b30.9b,c20.828.9b,c34.9b,c25.233.2a,b39.3b,c48.262.4a,b71.1b,c
    Smoking cessation counseling80.180.271.570.175.073.769.779.578.270.462.454.0
    Dietary counseling15.017.314.716.117.817.515.718.417.616.515.717.0
    Exercise counseling18.816.218.218.820.218.518.119.318.019.521.518.4
    Weight loss counseling51.853.147.951.148.546.156.154.049.647.040.747.0
    • Notes: All values adjusted for age, sex, practice location, and survey response, except abdominal aortic aneurysm screening, Chlamydia screening, and aspirin chemoprophylaxis use, for which sample sizes were too small for adjusting (ie, these values are unadjusted). P values compare the 4-month or the 16-month up-to-date value with the baseline up-to-date value.

    • ↵a P <.02.

    • ↵b Statistically significant increase in service delivery.

    • ↵c P <.001.

    • ↵d P <.05.

    • ↵e Statistically significant decrease in service delivery.

    • View popup
    Table 3

    Percentage Difference in Increase of Preventive Services at 4 or 16 Months From Baseline for Intervention vs Control or Users vs Nonusers

    Intervention vs Control (Intention to Treat)Users vs Nonusers (Subgroup Analysis)
    Indicated Preventive Services4 mo16 mo4 mo16 mo
    Overall delivery of indicated preventive services
    Patients up-to-date on all indicated services (all-or-none measure)1.12.3a,b2.49.3b,c
    Percentage of up-to-date services (composite measure)0.71.04.6b,c6.9b,d
    Delivery of selected, specific preventive services
    Colorectal cancer screening3.92.915.3b,c14.2b,c
    Breast cancer screening−2.9−1.912.3a,b7.7
    Cervical cancer screening−2.1−0.311.3b,c13.4b,c
    Tetanus immunization1.02.08.7b,c10.3b,c
    Influenza immunization2.94.35.23.0
    Pneumococcal immunization2.85.76.38.9
    • ↵a P <.05.

    • ↵b Statistically significant increase in net service delivery for intervention patients or users.

    • ↵c P <.02.

    • ↵d P <.001.

Additional Files

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  • The Article in Brief

    Interactive Preventive Health Record to Enhance Delivery of Recommended Care: A Randomized Trial

    Alex H. Krist , and colleagues

    Background Americans receive only one-half of recommended preventive services, in part because of poor access to reliable information. This study develops and tests an interactive preventive health record (IPHR), a health information system that provides patients with direct access to their electronic medical record.

    What This Study Found An interactive preventive health record that explains information in lay language and provides individualized recommendations, resources, and reminders is associated with a greater rate of being up-to-date on recommended preventive services. In a study of 4,500 patients in 8 primary care practices, patients received either usual care or a mailed invitation to use an interactive preventive health record. Despite fairly low rates of use, the proportion of patients up-to-date with all preventive services increased by 3.8 percent among intervention patients and by 1.5 percent among control patients. Greater increases were observed among patients who used the IPHR. At 16 months, 25 percent of users were up-to-date with all services, double the rate among nonusers. Moreover, at 4 months, delivery of colorectal, breast and cervical cancer screening increased by 19 percent, 15 percent, and 13 percent, respectively, among users.

    Implications

    • Information systems that feature patient-centered functionality, such as the IPHR, have potential to increase preventive service delivery.
  • Supplemental Appendix

    Supplemental Appendix. Screenshots Describing Interactive Preventive Health Record (IPHR) Content

    Files in this Data Supplement:

    • Supplemental data: Appendix - PDF file, 5 pages, 291 KB
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The Annals of Family Medicine: 10 (4)
The Annals of Family Medicine: 10 (4)
Vol. 10, Issue 4
July/August 2012
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Interactive Preventive Health Record to Enhance Delivery of Recommended Care: A Randomized Trial
Alex H. Krist, Steven H. Woolf, Stephen F. Rothemich, Robert E. Johnson, J. Eric Peele, Tina D. Cunningham, Daniel R. Longo, Ghalib A. Bello, Gary R. Matzke
The Annals of Family Medicine Jul 2012, 10 (4) 312-319; DOI: 10.1370/afm.1383

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Interactive Preventive Health Record to Enhance Delivery of Recommended Care: A Randomized Trial
Alex H. Krist, Steven H. Woolf, Stephen F. Rothemich, Robert E. Johnson, J. Eric Peele, Tina D. Cunningham, Daniel R. Longo, Ghalib A. Bello, Gary R. Matzke
The Annals of Family Medicine Jul 2012, 10 (4) 312-319; DOI: 10.1370/afm.1383
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