Article Figures & Data
Figures
- 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
Characteristic Control 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 18–34 446 (19.8) 444 (19.7) 413 (22.0) 31 (8.2) 35–49 675 (30.0) 677 (30.1) 580 (31.0) 97 (25.7) 50–64 676 (30.0) 676 (30.0) 524 (28.0) 152 (40.2) 65–75 453 (20.1) 453 (20.1) 355 (19.0) 98 (25.9) Sex Male 1125 (50.0 1,126 (50.0) 915 (48.9) 211 (55.8) Female 1125 (50.0) 1,124 (50.0) 957 (51.1) 167 (44.2) Raceb White 1,251 (79.6) 1,206 (79.2) 923 (78.1) 283 (83.5) African American 93 (6.0) 100 (6.6) 78 (6.6) 22 (6.5) Asian 149 (9.4) 145 (9.5) 120 (10.1) 25 (7.4) Other 63 (4.0) 51 (3.4) 42 (3.6) 9 (2.6) Unknown 16 (1.0) 19 (1.3) 19 (1.6) 0 (0.0) Hispanic ethnicityb Hispanic 95 (6.0) 90 (5.9) 81 (6.9) 9 (2.7) Non-Hispanic 1,477 (94.0) 1,431 (94.1) 1,101 (93.1) 330 (97.3) Educationb College or higher 777 (67.7) 735 (64.5) 540 (62.8) 195 (69.9) Less than college 371 (32.3) 404 (35.5) 320 (37.2) 84 (30.1) Comorbidities Diabetes 208 (9.2) 192 (8.5) 153 (8.2) 39 (10.3) Cancer 68 (3.0) 75 (3.3) 55 (2.9) 20 (5.3) Coronary artery disease 96 (4.3) 98 (4.4) 75 (4.0) 23 (6.1) Hyperlipidemia 733 (32.6) 696 (30.9) 544 (29.1) 152 (40.2) Hypertension 646 (28.7) 634 (28.2) 488 (26.1) 146 (38.6) Use Internet at least once per dayb 868 (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).
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↵b Only includes survey respondents, as data were not available in the electronic health record.
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- 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 Services Baseline 4 mo 16 mo Baseline 4 mo 16 mo Baseline 4 mo 16 mo Baseline 4 mo 16 mo Overall delivery of indicated preventive services Patients up-to-date on all indicated services (all-or-none measure) 11.1 12.1 12.6 11.4 13.5a,b 15.2b,c 11.7 13.4 13.9b,d 13.6 17.8 25.1b,c Percentage of up-to- date services (composite measure) 61.4 62.1 59.2c,e 61.7 63.1b,d 60.4 60.9 61.5 58.5a,e 64.9 70.1b,c 69.4a,b Delivery of specific preventive services Colorectal cancer screening 36.8 40.4 43.9b,d 37.7 45.2a,b 47.8b,c 40.0 43.9 46.6a,b 53.0 72.2a,b 73.9b,c Breast cancer screening 44.1 53.2b,d 29.6c,e 52.4 58.5 35.8c,e 52.9 55.7 36.2c,e 75.1 90.1b,d 66.1 Cervical cancer screening 67.6 71.8 68.4 72.7 74.9 73.3 71.5 72.0 71.0 79.5 91.2a,b 92.4a,b Prostate cancer screening 56.8 46.5c,e 48.9a,e 50.8 48.5 52.3 47.0 46.2 52.0 71.8 65.0 62.0 Hypertension screening 99.9 98.1c,e 93.0c,e 100.0 98.6c,e 92.8c,e 99.9 94.5c,e 79.9c,e 100.0 99.5 96.6c,e Hypercholesterolemia screening 82.8 86.0a,b 85.9b,d 80.7 83.2 b,d 85.2b,c 79.7 82.1 84.5b,c 91.1 93.2 93.3 Abdominal aortic aneurysm screening 24.0 22.7 25.3 24.6 23.7 25.4 28.5 22.7 22.6 15.4 25.9 32.1 Diabetes screening 77.1 80.6 82.0a,b 74.9 81.3a,b 84.5b,c 76.1 82.6a,b 84.9b,c 87.9 90.6 96.7a,b Chlamydia screening 21.1 10.2 21.7 17.8 10.0 21.3 – – – – – – Osteoporosis screening 39.7 41.9 48.5 45.2 51.1 57.9b,d 38.2 41.0 51.7b,d 72.0 90.6 96.3 Aspirin chemoprophylaxis use 53.1 58.9 58.8 61.0 56.8 57.6 61.8 56.7 55.5 58.3 57.1 64.8 Tetanus immunization 46.9 52.3a,b 51.4a,b 46.4 52.8b,c 52.8b,c 51.1 55.7a,b 55.7a,b 57.6 70.9a,b 72.6b,c Influenza immunization 30.7 28.6 27.5 29.6 30.3 30.6 29.2 28.8 29.6 37.3 42.1 40.7 Pneumococcal immunization 22.5 27.8a,b 30.9b,c 20.8 28.9b,c 34.9b,c 25.2 33.2a,b 39.3b,c 48.2 62.4a,b 71.1b,c Smoking cessation counseling 80.1 80.2 71.5 70.1 75.0 73.7 69.7 79.5 78.2 70.4 62.4 54.0 Dietary counseling 15.0 17.3 14.7 16.1 17.8 17.5 15.7 18.4 17.6 16.5 15.7 17.0 Exercise counseling 18.8 16.2 18.2 18.8 20.2 18.5 18.1 19.3 18.0 19.5 21.5 18.4 Weight loss counseling 51.8 53.1 47.9 51.1 48.5 46.1 56.1 54.0 49.6 47.0 40.7 47.0 -
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.
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↵a P <.02.
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↵b Statistically significant increase in service delivery.
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↵c P <.001.
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↵d P <.05.
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↵e Statistically significant decrease in service delivery.
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- 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 Services 4 mo 16 mo 4 mo 16 mo Overall delivery of indicated preventive services Patients up-to-date on all indicated services (all-or-none measure) 1.1 2.3a,b 2.4 9.3b,c Percentage of up-to-date services (composite measure) 0.7 1.0 4.6b,c 6.9b,d Delivery of selected, specific preventive services Colorectal cancer screening 3.9 2.9 15.3b,c 14.2b,c Breast cancer screening −2.9 −1.9 12.3a,b 7.7 Cervical cancer screening −2.1 −0.3 11.3b,c 13.4b,c Tetanus immunization 1.0 2.0 8.7b,c 10.3b,c Influenza immunization 2.9 4.3 5.2 3.0 Pneumococcal immunization 2.8 5.7 6.3 8.9
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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