Alex H Krist1,2, Steven H Woolf3,2,4, Camille Hochheimer3,5, Roy T Sabo3,5, Paulette Kashiri3, Resa M Jones3,2, Jennifer Elston Lafata6,7,8, Rebecca S Etz3, Shin-Ping Tu9. 1. Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia ahkrist@vcu.edu. 2. Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia. 3. Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia. 4. Center on Society and Health, Virginia Commonwealth University, Richmond, Virginia. 5. Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia. 6. Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina Chapel Hill, Chapel Hill, North Carolina. 7. Lineberger Comprehensive Cancer Center, University of North Carolina Chapel Hill, Chapel Hill, North Carolina. 8. Institute for Healthcare Quality Improvement, School of Medicine, University of North Carolina Chapel Hill, Chapel Hill, North Carolina. 9. School of Public Health, University of Washington, Seattle, Washington.
Abstract
PURPOSE: Technology could transform routine decision making by anticipating patients' information needs, assessing where patients are with decisions and preferences, personalizing educational experiences, facilitating patient-clinician information exchange, and supporting follow-up. This study evaluated whether patients and clinicians will use such a decision module and its impact on care, using 3 cancer screening decisions as test cases. METHODS: Twelve practices with 55,453 patients using a patient portal participated in this prospective observational cohort study. Participation was open to patients who might face a cancer screening decision: women aged 40 to 49 who had not had a mammogram in 2 years, men aged 55 to 69 who had not had a prostate-specific antigen test in 2 years, and adults aged 50 to 74 overdue for colorectal cancer screening. Data sources included module responses, electronic health record data, and a postencounter survey. RESULTS: In 1 year, one-fifth of the portal users (11,458 patients) faced a potential cancer screening decision. Among these patients, 20.6% started and 7.9% completed the decision module. Fully 47.2% of module completers shared responses with their clinician. After their next office visit, 57.8% of those surveyed thought their clinician had seen their responses, and many reported the module made their appointment more productive (40.7%), helped engage them in the decision (47.7%), broadened their knowledge (48.1%), and improved communication (37.5%). CONCLUSIONS: Many patients face decisions that can be anticipated and proactively facilitated through technology. Although use of technology has the potential to make visits more efficient and effective, cultural, workflow, and technical changes are needed before it could be widely disseminated.
PURPOSE: Technology could transform routine decision making by anticipating patients' information needs, assessing where patients are with decisions and preferences, personalizing educational experiences, facilitating patient-clinician information exchange, and supporting follow-up. This study evaluated whether patients and clinicians will use such a decision module and its impact on care, using 3 cancer screening decisions as test cases. METHODS: Twelve practices with 55,453 patients using a patient portal participated in this prospective observational cohort study. Participation was open to patients who might face a cancer screening decision: women aged 40 to 49 who had not had a mammogram in 2 years, men aged 55 to 69 who had not had a prostate-specific antigen test in 2 years, and adults aged 50 to 74 overdue for colorectal cancer screening. Data sources included module responses, electronic health record data, and a postencounter survey. RESULTS: In 1 year, one-fifth of the portal users (11,458 patients) faced a potential cancer screening decision. Among these patients, 20.6% started and 7.9% completed the decision module. Fully 47.2% of module completers shared responses with their clinician. After their next office visit, 57.8% of those surveyed thought their clinician had seen their responses, and many reported the module made their appointment more productive (40.7%), helped engage them in the decision (47.7%), broadened their knowledge (48.1%), and improved communication (37.5%). CONCLUSIONS: Many patients face decisions that can be anticipated and proactively facilitated through technology. Although use of technology has the potential to make visits more efficient and effective, cultural, workflow, and technical changes are needed before it could be widely disseminated.
Authors: Alex H Krist; Steven H Woolf; Stephen F Rothemich; Robert E Johnson; J Eric Peele; Tina D Cunningham; Daniel R Longo; Ghalib A Bello; Gary R Matzke Journal: Ann Fam Med Date: 2012 Jul-Aug Impact factor: 5.166
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Authors: Steven H Woolf; Alex H Krist; Jennifer Elston Lafata; Resa M Jones; Rebecca R Lehman; Camille J Hochheimer; Roy T Sabo; Dominick L Frosch; Brian J Zikmund-Fisher; Daniel R Longo Journal: Am J Prev Med Date: 2017-12-11 Impact factor: 5.043
Authors: Jennifer Elston Lafata; Yongyun Shin; Susan A Flocke; Sarah T Hawley; Resa M Jones; Ken Resnicow; Michelle Schreiber; Deirdre A Shires; Shin-Ping Tu Journal: BMJ Open Date: 2019-01-07 Impact factor: 2.692