Randomized Controlled Trial of Health Maintenance Reminders Provided Directly to Patients Through an Electronic PHR
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Provider and patient reminders can be effective in increasing rates of preventive screenings and vaccinations. However, the effect of patient-directed electronic reminders is understudied.
To determine whether providing reminders directly to patients via an electronic Personal Health Record (PHR) improved adherence to care recommendations.
We conducted a cluster randomized trial without blinding from 2005 to 2007 at 11 primary care practices in the Partners HealthCare system.
A total of 21,533 patients with access to a PHR were invited to the study, and 3,979 (18.5%) consented to enroll.
Patients in the intervention arm received health maintenance (HM) reminders via a secure PHR “eJournal,” which allowed them to review and update HM and family history information. Patients in the active control arm received access to an eJournal that allowed them to input and review information related to medications, allergies and diabetes management.
The primary outcome measure was adherence to guideline-based care recommendations.
Intention-to-treat analysis showed that patients in the intervention arm were significantly more likely to receive mammography (48.6% vs 29.5%, p = 0.006) and influenza vaccinations (22.0% vs 14.0%, p = 0.018). No significant improvement was observed in rates of other screenings. Although Pap smear completion rates were higher in the intervention arm (41.0% vs 10.4%, p < 0.001), this finding was no longer significant after excluding women’s health clinics. Additional on-treatment analysis showed significant increases in mammography (p = 0.019) and influenza vaccination (p = 0.015) for intervention arm patients who opened an eJournal compared to control arm patients, but no differences for any measure among patients who did not open an eJournal.
Providing patients with HM reminders via a PHR may be effective in improving some elements of preventive care.
KEY WORDShealth maintenance reminders personal health record preventive care clinical decision support Patient Gateway
This work was partially supported by AHRQ Grant R01-HS013660-02: Shared Online Health Records for Patient Safety and Quality. AHRQ was not involved in the design, execution or analysis of the study, or in the preparation of this manuscript. The study protocol was approved by the Partners HealthCare Human Research Committee and registered at ClinicalTrials.gov (NCT00251875).
Conflicts of Interest
- 3.IOM. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001.Google Scholar
- 7.Shojania KG, Jennings A, Mayhew A, Ramsay CR, Eccles MP, Grimshaw J. The effects of on-screen, point of care computer reminders on processes and outcomes of care. Cochrane Database Syst Rev. 2009(3):CD001096.Google Scholar
- 8.Blumenthal D, Tavenner M. The Meaningful Use Regulation for Electronic Health Records. N Engl J Med. 2010;363(6):501–4.Google Scholar
- 11.Thomas RE, Russell M, Lorenzetti D. Interventions to increase influenza vaccination rates of those 60 years and older in the community. Cochrane Database Syst Rev. 2010(9):CD005188.Google Scholar
- 14.Poon EG, Wald J, Bates DW, Middleton B, Kuperman GJ, Gandhi TK. Supporting patient care beyond the clinical encounter: three informatics innovations from partners health care. AMIA Annu Symp Proc. 2003:1072.Google Scholar
- 15.Wald J, Businger A, Gandhi T, et al. Implementing practice-linked pre-visit electronic journals in primary care: patient and physician use and satisfaction. J Am Med Inform Assoc. 2010.Google Scholar
- 19.Siteman E, Businger A, Gandhi T, et al. Physicians value patient review of their electronic health record data as a means to improve accuracy of medication list documentation. AMIA Annu Symp Proc. 2007:1116.Google Scholar
- 25.Ash JS, Sittig DF, Campbell EM, Guappone KP, Dykstra RH. Some unintended consequences of clinical decision support systems. AMIA Annu Symp Proc. 2007:26–30.Google Scholar
- 27.Kim EH, Kim Y. Digital divide: Use of electronic personal health record by different population groups. Conf Proc IEEE Eng Med Biol Soc. 2010;1:1759–62.Google Scholar