title: MyPreventiveCare: implementation and dissemination of an interactive preventive health record in three practice-based research networks serving disadvantaged patients--a randomized cluster trial.
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
  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.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT02138448.
authors.affiliation: Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, Virginia. ahkrist@vcu.edu.
authors.forename: Alex H
authors.initials: AH
authors.lastname: Krist
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Aycock
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Etz
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Devoe
authors.forename: Roy T
authors.initials: RT
authors.lastname: Sabo
authors.forename: Robert
authors.initials: R
authors.lastname: Williams
authors.forename: Karen L
authors.initials: KL
authors.lastname: Stein
authors.forename: Gary
authors.initials: G
authors.lastname: Iwamoto
authors.forename: Jon
authors.initials: J
authors.lastname: Puro
authors.forename: Jon
authors.initials: J
authors.lastname: Deshazo
authors.forename: Paulette Lail
authors.initials: PL
authors.lastname: Kashiri
authors.forename: Jill
authors.initials: J
authors.lastname: Arkind
authors.forename: Crystal
authors.initials: C
authors.lastname: Romney
authors.forename: Miria
authors.initials: M
authors.lastname: Kano
authors.forename: Christine
authors.initials: C
authors.lastname: Nelson
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Longo
authors.forename: Susan
authors.initials: S
authors.lastname: Wolver
authors.forename: Steven H
authors.initials: SH
authors.lastname: Woolf
mesh_terms: D000328:Adult; D000368:Aged; D016000:Cluster Analysis; D004059:Diffusion of Innovation; D042241:Early Diagnosis; D057286:Electronic Health Records; D005240:Feasibility Studies; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008490:Medical Informatics; D008875:Middle Aged; D018802:Patient-Centered Care / Q000379:methods; D011320:Primary Health Care / Q000458:organization & administration; D014768:Virginia