Implementing Personal Health Records to Promote Evidence-Based Cancer Screening

Conditions:Cancer, Cancer, Healthy Studies
Therapuetic Areas:Oncology, Other
Age Range:18 - 75
Start Date:January 2017
End Date:April 2020
Contact:Alexander H Krist, MD, MPH

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Cancer screening can improve the length and quality of life, yet the average American
receives only half of recommended services. Patient-centered personal health records with
higher levels of functionality, combined with practice redesign to make use of these
functions, can help patients obtain recommended cancer screening tests by linking them to
their doctor's records, explaining information in lay language, displaying tailored
recommendations and educational resources, providing logistical support and tools to
stimulate action, and generating reminders. This project will measure whether making these
resources available to primary care practices and patients promotes shared decision-making
and increases the delivery of cancer screening compared to existing information systems.

We developed a theory-driven interactive Patient Health Record (PHR) that uses higher
functionality to more deeply engage patients in health promotion. The model defines five
levels of PHR 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. We hypothesize that implementing PHRs with these higher levels of
functionality will inform and activate patients in ways that simpler PHRs cannot achieve and
will increase uptake of preventive services. In Phase 1, we will randomize 46 practices from
three practice-based research networks in eight states to implement a PHR with advanced
versus simpler functionality. Control practices will use their existing PHR. Intervention
practices will upgrade their PHR to feature an interactive preventive health record (IPHR)
that we have previously developed and tested. Intervention practices will locally tailor the
IPHR content and learn how to integrate new functions into practice. 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 randomized comparison of intervention and control practices will measure
the incremental effect of the IPHR on shared decision-making and receipt of cancer screening
tests compared to traditional PHRs (Effectiveness). Data sources will include the
EHR/PHR/IPHR databases, patient and practice surveys, recruitment field notes, practice
learning collaborative transcripts, practice diaries, and patient phone interviews. This
study will inform future efforts to use patient-centered information technology to promote
cancer prevention and the feasibility of national dissemination.

Inclusion Criteria:

1. Practices in a practice based research network participating in our study that have an
existing patient health record

2. Patients that attend our study practices

Exclusion Criteria:

Practices without a patient health record
We found this trial at
Albuquerque, New Mexico 87131
Principal Investigator: Robert Williams, MD
Phone: 505-272-2437
Albuquerque, NM
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Portland, Oregon 97201
Principal Investigator: Jennifer Devoe, MD DrPhil
Phone: 503-943-2500
Portland, OR
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711 West Main Street
Richmond, Virginia 23298
Principal Investigator: Alexander H Krist, MD, MPH
Phone: 804-827-6750
Richmond, VA
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