title: Impact of electronic personal health record use on engagement and intermediate health outcomes among cardiac patients: a quasi-experimental study.
abstract: OBJECTIVE
  To determine the impact of tethered personal health record (PHR) use on patient engagement and intermediate health outcomes among patients with coronary artery disease (CAD).
  
  
  METHODS
  Adult CAD patients (N = 200) were enrolled in this prospective, quasi-experimental observational study. Each patient received a PHR account and training on its use. PHRs were populated with information from patient electronic medical records, hosted by a Health Information Exchange. Intermediate health outcomes including blood pressure, body mass index, and hemoglobin A1c (HbA1c) were evaluated through electronic medical record review or laboratory tests. Trends in patient activation measure® (PAM) were determined through three surveys conducted at baseline, 6 and 12 months. Frequency of PHR use data was collected and used to classify participants into groups for analysis: Low, Active, and Super users.
  
  
  RESULTS
  There was no statistically significant improvement in patient engagement as measured by PAM scores during the study period. HbA1c levels improved significantly in the Active and Super user groups at 6 months; however, no other health outcome measures improved significantly. Higher PAM scores were associated with lower body mass index and lower HbA1c, but there was no association between changes in PAM scores and changes in health outcomes. Use of the PHR health diary increased significantly following PHR education offered at the 6-month study visit and an elective group refresher course.
  
  
  CONCLUSIONS
  The study findings show that PHR use had minimal impact on intermediate health outcomes and no significant impact on patient engagement among CAD patients.
authors.affiliation: Parkview Research Center, Parkview Health, Fort Wayne, Indiana, USA Indiana University School of Informatics and Computing, Indianapolis, Indiana, USA tammy.toscos@parkview.com.
authors.forename: Tammy
authors.initials: T
authors.lastname: Toscos
authors.affiliation: Parkview Research Center, Parkview Health, Fort Wayne, Indiana, USA.
authors.forename: Carly
authors.initials: C
authors.lastname: Daley
authors.affiliation: Parkview Research Center, Parkview Health, Fort Wayne, Indiana, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Heral
authors.affiliation: Department of Community Medicine, University of Connecticut, Hartford, Connecticut, USA.
authors.forename: Riddhi
authors.initials: R
authors.lastname: Doshi
authors.affiliation: College of Pharmacy, Manchester University, Fort Wayne, Indiana, USA.
authors.forename: Yu-Chieh
authors.initials: YC
authors.lastname: Chen
authors.affiliation: Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: George J
authors.initials: GJ
authors.lastname: Eckert
authors.affiliation: Parkview Research Center, Parkview Health, Fort Wayne, Indiana, USA Indiana University School of Medicine, Fort Wayne, Indiana, USA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Plant
authors.affiliation: Parkview Research Center, Parkview Health, Fort Wayne, Indiana, USA Indiana University School of Medicine, Fort Wayne, Indiana, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mirro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003197:Computer Literacy; D003324:Coronary Artery Disease / Q000097:blood / Q000628:therapy*; D059026:Diagnostic Self Evaluation; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D055991:Health Records, Personal; D006304:Health Status; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: and patient engagement.; coronary artery disease; health outcomes; patient activation measure; patient portal; personal health records