title: Engaging patients through open notes: an evaluation using mixed methods.
abstract: OBJECTIVE
  (A) To gain insights into the experiences of patients invited to view their doctors' visit notes, with a focus on those who review multiple notes; (B) to examine the relationships among fully transparent electronic medical records and quality of care, the patient-doctor relationship, patient engagement, self-care, self-management skills and clinical outcomes.
  
  
  METHODS
  Mixed methods qualitative study: analyses of survey data, including content analysis of free-text answers, and quantitative-descriptive measures combined with semistructured individual interviews, patient activation measures, and member checks.
  
  
  METHODS
  Greater Boston, USA.
  
  
  METHODS
  Patients cared for by primary care physicians (PCPs) at the Beth Israel Deaconess Medical Center who had electronic access to their PCP visit notes. Among those submitting surveys, 576 free-text answers were identified and analysed (414 from female patients, 162 from male patients; 23-88 years). In addition, 13 patients (9 female, 4 male; 58-87 years) were interviewed.
  
  
  RESULTS
  Patient experiences indicate improved understanding (of health information), better relationships (with doctors), better quality (adherence and compliance; keeping track) and improved self-care (patient-centredness, empowerment). Patients want more doctors to offer access to their notes, and some wish to contribute to their generation. Those patients with repeated experience reviewing notes express fewer concerns and more perceived benefits.
  
  
  CONCLUSIONS
  As the use of fully transparent medical records spreads, it is important to gain a deeper understanding of possible benefits or harms, and to characterise target populations that may require varying modes of delivery. Patient desires for expansion of this practice extend to specialty care and settings beyond the physician's office. Patients are also interested in becoming involved actively in the generation of their medical records. The OpenNotes movement may increase patient activation and engagement in important ways.
authors.affiliation: Division of General Medicine and Primary Care, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA Division of Integrative Health Promotion, Coburg University of Applied Sciences, Coburg, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Esch
authors.affiliation: Division of General Medicine and Primary Care, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
authors.forename: Roanne
authors.initials: R
authors.lastname: Mejilla
authors.affiliation: Division of General Medicine and Primary Care, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Anselmo
authors.affiliation: Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Podtschaske
authors.affiliation: Division of General Medicine and Primary Care, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
authors.forename: Tom
authors.initials: T
authors.lastname: Delbanco
authors.affiliation: Division of General Medicine and Primary Care, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
authors.forename: Jan
authors.initials: J
authors.lastname: Walker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001900:Boston; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D033283:Patient Access to Records; D010358:Patient Participation; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D036301:Qualitative Research; D011787:Quality of Health Care; D012648:Self Care; D055815:Young Adult
keywords: GENERAL MEDICINE (see Internal Medicine); PRIMARY CARE; Patient Activation; QUALITATIVE RESEARCH; Self-Care
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