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Implementation Science
Published in: Implementation Science 1/2014

Open Access 01-12-2014 | Study protocol

MyPreventiveCare: implementation and dissemination of an interactive preventive health record in three practice-based research networks serving disadvantaged patients—a randomized cluster trial

Authors: Alex H Krist, Rebecca A Aycock, Rebecca S Etz, Jennifer E Devoe, Roy T Sabo, Robert Williams, Karen L Stein, Gary Iwamoto, Jon Puro, Jon Deshazo, Paulette Lail Kashiri, Jill Arkind, Crystal Romney, Miria Kano, Christine Nelson, Daniel R Longo, Susan Wolver, Steven H Woolf

Published in: Implementation Science | Issue 1/2014

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Abstract

Background

Evidence-based preventive services for early detection of cancer and other health conditions offer profound health benefits, yet Americans receive only half of indicated services. Policy initiatives promote the adoption of information technologies to engage patients in care. We developed a theory-driven interactive preventive health record (IPHR) to engage patients in health promotion. The model defines five levels of functionality: (1) collecting patient information, (2) integrating with electronic health records (EHRs), (3) translating information into lay language, (4) providing individualized, guideline-based clinical recommendations, and (5) facilitating patient action. It is hypothesized that personal health records (PHRs) with these higher levels of functionality will inform and activate patients in ways that simpler PHRs cannot. However, realizing this vision requires both technological advances and effective implementation based upon clinician and practice engagement.

Methods/design

We are starting a two-phase, mixed-method trial to evaluate whether the IPHR is scalable across a large number of practices and how its uptake differs for minority and disadvantaged patients. In phase 1, 40 practices from three practice-based research networks will be randomized to add IPHR functionality to their PHR versus continue to use their existing PHR. Throughout the study, we will engage intervention practices to locally tailor IPHR content and learn how to integrate new functions into their practice workflow. In phase 2, the IPHR to all nonintervention practices to observe whether the IPHR can be implemented more broadly (Scalability). Phase 1 will feature an implementation assessment in intervention practices, based on the RE-AIM model, to measure Reach (creation of IPHR accounts by patients), Adoption (practice decision to use the IPHR), Implementation (consistency, fidelity, barriers, and facilitators of use), and Maintenance (sustained use). The incremental effect of the IPHR on receipt of cancer screening tests and shared decision-making compared to traditional PHRs will assess Effectiveness. In phase 2, we will assess similar outcomes as phase 1 except for effectiveness.

Discussion

This study will yield information about the effectiveness of new health information technologies designed to actively engage patients in their care as well as information about how to effectively implement and disseminate PHRs by engaging clinicians.

Trial registration

ClinicalTrials.gov: NCT02138448
Appendix
Available only for authorised users
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Metadata
Title
MyPreventiveCare: implementation and dissemination of an interactive preventive health record in three practice-based research networks serving disadvantaged patients—a randomized cluster trial
Authors
Alex H Krist
Rebecca A Aycock
Rebecca S Etz
Jennifer E Devoe
Roy T Sabo
Robert Williams
Karen L Stein
Gary Iwamoto
Jon Puro
Jon Deshazo
Paulette Lail Kashiri
Jill Arkind
Crystal Romney
Miria Kano
Christine Nelson
Daniel R Longo
Susan Wolver
Steven H Woolf
Publication date
01-12-2014
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2014
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/s13012-014-0181-1

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