Impact of a Personalized Portal for Prevention – MyPreventiveCare

1. Impact of a Personalized Portal for Prevention – MyPreventiveCare Alex Krist MD MPH, Robert Johnson PhD, Steven Woolf MD MPH, Daniel Longo ScD, Stephen Rothemich MD MS, Eric Peele (RTI International), William Kerns MD, Anton Kuzel MD MHPE MyPreventiveCare Design MyPreventiveCare Use 461 of 2250 (20.5%) invited patients used the system • Background • Americans receive only half of recommended care. • Multiple interventions increase delivery of prevention such as giving patients: a) control of their records, b) personalized messages, c) specific recommendations, d) educational material, e) decision aids, f) self-management supports, and g) reminders • All of these can be integrated into a highly sophisticated personal health record to promote patient-centered preventive care, called MyPreventiveCare. • Objective • To design and test in a randomized controlled trial whether MyPreventiveCare increases the delivery of U.S. Preventive Services Task Force (USPSTF) endorsed screening tests, counseling services, chemoprophylaxis, and immunizations. • Setting • 8 family medicine practices (Fairfax Family Practice Centers) in the VACORN network that use a common electronic medical record (EMR). The practices range in size from 2 to 35 providers – one is a residency, the rest are private practices. • Participants • Of 78,000 active patients, 4500 patients age 18 to 75 were randomly selected to participate (stratified by age and gender) – half intervention and half control patients. • Intervention • On 11/17/08, 12/15/08, and 7/27/09, intervention patients were mailed an invitation to use MyPreventiveCare. Control patients continued to receive usual care. • Outcomes Assessment • We collected EMR and patient survey data Feb 2008 (baseline) and Feb 2009 (post-intervention) . Combining the responses, we determine if patients invited to use MyPreventiveCare were more likely to be up-to-date with recommended services. Provides patient a list of their personal prevention needs • EMR Data • MyPreventiveCare uses 167 EMR data elements: • Diagnoses • Vital signs • Medications • Orders • Results • Immunizations • Topics addressed: • Colon cancer • Breast cancer • Cervical cancer • Prostate cancer • Chlamydia screening • Blood pressure screening • Cholesterol screening • AAA screening • Aspirin • Diabetes screening • Osteoporosis screening • Pneumonia vaccine • Influenza vaccine • Tetanus vaccine • Diet • Exercise • Smoking • Weight Patient can open individually tailored prevention messages Decision support Logic determines patient’s prevention needs based on USPSTF recommendations Tailored messages contain individualized educational links • Health Risk Assessment • Patient answers 11 or 12 health risk questions • Race • Health behaviors • Family history • Abnormal test results Clinician is sent a summary of patient’s prevention needs • Impact of MyPreventiveCareon Delivery of Preventive Services • MyPreventiveCareidentified that users were up-to-date date with only 53% of preventive services • – 49% needed a screening test, 91% needed to • change a health behavior, 56% needed a • vaccination, 55% needed chemoprevention • MyPreventiveCaresummaries led practices to • – update 59% of patients’ records • – schedule a visit for 44% of patients • – deliver a specific service to 19% of patients Reminders are sent to patient when services become overdue Users were more up-to-date than non-users Example: Personalized Message Example: Prevention Recommendations % of preventive services up-to-date • Conclusions • While we did not observe a difference between our intervention group (patients mailed an invitation to use MyPreventiveCare) and usual care, patients who used MyPreventiveCare had a substantial increase in being up-to-date with preventive care compared to non-users. More effective integration of MyPreventiveCare into daily clinical activities is needed to promote successful patient system adoption. • Next Steps • We are systematically evaluating how to adoptMyPreventiveCare on a practice-wide scale and integrate it into daily clinical activities to promote increased use (R21HS18811-1, Feb 2010 – Jan 2012). • We are systematically evaluating how to implement MyPreventiveCare in primary care practices that use different EMRs with a wide range of locations, patient populations, internet use, EMR experience, PHR experience, IT infrastructure, and practice culture (290-07-100113, Sept 2009 – Aug 2011) Funded by the Agency for Healthcare Research and Quality (R18 HS17046-01) Virginia Ambulatory Care Outcomes Research Network (ACORN), Department of Family Medicine, Virginia Commonwealth University