title: Patterns of response to patient-centered decision support through a personal health record.
abstract: BACKGROUND
  Over 140 million people in the United States have at least one chronic medical condition, but they receive fewer than 60% of guideline-recommended services for these conditions. Increasing patients' involvement in their own care may improve the receipt of guideline-recommended services. We evaluated patients' patterns of responses to notifications regarding guideline-recommended services delivered through a personalized health record (PHR).
  
  
  METHODS
  We enrolled 584 participants with high cardiovascular disease risk from 73 primary care practices into an active PHR in which they received patient-centered decision support-notifications delivered via a PHR regarding prevention gaps (i.e., unmet preventive healthcare or chronic disease monitoring). Participants with prevention gaps received up to three weekly messages regarding all services due within a 2-month time frame. These three-message cycles could repeat up to every 2 months for a new, or continuing, prevention gap.
  
  
  RESULTS
  Of the 584 participants, 501 (86%) received at least one reminder. Approximately 61% of these participants accessed the PHR or received the care that triggered the message after the first message and 73% after the first two messages. In subsequent three-message cycles, we observed no change in the number of messages required prior to participants accessing the PHR or receiving recommended care (chi-squared = 12.4, p = 0.3). Of the 2,656 prevention gaps these participants had over 1 year, 1,539 (58%) were closed.
  
  
  CONCLUSIONS
  In this low-intensity intervention, participants accessed the PHR and received recommended care. Providing notification through the PHR allows patients to choose when they receive, and take action on, the message. Notifications can be provided to patients through a PHR without alert fatigue and may be an additional tool to help patients achieve better health.
authors.affiliation: 1 Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania.
authors.forename: Rachel
authors.initials: R
authors.lastname: Hess
authors.forename: Gary S
authors.initials: GS
authors.lastname: Fischer
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Sullivan
authors.forename: XinXin
authors.initials: X
authors.lastname: Dong
authors.forename: Melissa
authors.initials: M
authors.lastname: Weimer
authors.forename: Caroline
authors.initials: C
authors.lastname: Zeith
authors.forename: Sunday
authors.initials: S
authors.lastname: Clark
authors.forename: Mark S
authors.initials: MS
authors.lastname: Roberts
mesh_terms: D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003661:Decision Support Techniques; D019468:Disease Management; D005260:Female; D055991:Health Records, Personal; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D018802:Patient-Centered Care; D010414:Pennsylvania; D011320:Primary Health Care; D017010:Reminder Systems; D012648:Self Care; D014481:United States
keywords: chronic disease; health information technology; patient activation; patient engagement