Richard W Grant1, Courtney Lyles2,3, Connie S Uratsu2, Michelle T Vo2, Elizabeth A Bayliss4,5, Michele Heisler6,7. 1. Division of Research, Kaiser Permanente Northern California, Oakland, California Richard.W.Grant@kp.org. 2. Division of Research, Kaiser Permanente Northern California, Oakland, California. 3. Center for Vulnerable Populations and Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, California. 4. Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado. 5. Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado. 6. Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan. 7. University of Michigan Department of Internal Medicine, Ann Arbor, Michigan.
Abstract
PURPOSE: Time during primary care visits is limited. We tested the hypothesis that a waiting room health information technology (IT) tool to help patients identify and voice their top visit priorities would lead to better visit interactions and improved quality of care. METHODS: We designed a waiting room tool, the Visit Planner, to guide adult patients through the process of identifying their top priorities for their visit and effectively expressing these priorities to their clinician. We tested this tool in a cluster-randomized controlled trial with usual care as the control. Eligible patients had at least 1 clinical care gap (eg, overdue for cancer screening, suboptimal chronic disease risk factor control, or medication nonadherence). RESULTS:The study (conducted March 31, 2016 through December 31, 2017) included 750 English- or Spanish-speaking patients. Compared with usual care patients, intervention patients more often reported "definitely" preparing questions for their doctor (59.5% vs 45.1%, P <.001) and "definitely" expressing their top concerns at the beginning of the visit (91.3% vs 83.3%, P = .005). Patients in both arms reported high levels of satisfaction with their care (86.8% vs 89.9%, P = .20). With 6 months of follow-up, prevalence of clinical care gaps was reduced by a similar amount in each study arm. CONCLUSIONS: A simple waiting room-based tool significantly improved visit communication. Patients using the Visit Planner were more prepared and more likely to begin the visit by communicating their top priorities. These changes did not, however, lead to further reduction in aggregate clinical care gaps beyond the improvements seen in the usual care arm.
RCT Entities:
PURPOSE: Time during primary care visits is limited. We tested the hypothesis that a waiting room health information technology (IT) tool to help patients identify and voice their top visit priorities would lead to better visit interactions and improved quality of care. METHODS: We designed a waiting room tool, the Visit Planner, to guide adult patients through the process of identifying their top priorities for their visit and effectively expressing these priorities to their clinician. We tested this tool in a cluster-randomized controlled trial with usual care as the control. Eligible patients had at least 1 clinical care gap (eg, overdue for cancer screening, suboptimal chronic disease risk factor control, or medication nonadherence). RESULTS: The study (conducted March 31, 2016 through December 31, 2017) included 750 English- or Spanish-speaking patients. Compared with usual care patients, intervention patients more often reported "definitely" preparing questions for their doctor (59.5% vs 45.1%, P <.001) and "definitely" expressing their top concerns at the beginning of the visit (91.3% vs 83.3%, P = .005). Patients in both arms reported high levels of satisfaction with their care (86.8% vs 89.9%, P = .20). With 6 months of follow-up, prevalence of clinical care gaps was reduced by a similar amount in each study arm. CONCLUSIONS: A simple waiting room-based tool significantly improved visit communication. Patients using the Visit Planner were more prepared and more likely to begin the visit by communicating their top priorities. These changes did not, however, lead to further reduction in aggregate clinical care gaps beyond the improvements seen in the usual care arm.
Authors: Truls Østbye; Kimberly S H Yarnall; Katrina M Krause; Kathryn I Pollak; Margaret Gradison; J Lloyd Michener Journal: Ann Fam Med Date: 2005 May-Jun Impact factor: 5.166
Authors: Terry S Field; Jerry H Gurwitz; Leslie R Harrold; Jeffrey Rothschild; Kristin R DeBellis; Andrew C Seger; Jill C Auger; Leslie A Garber; Cynthia Cadoret; Leslie S Fish; Lawrence D Garber; Michael Kelleher; David W Bates Journal: J Am Geriatr Soc Date: 2004-08 Impact factor: 5.562
Authors: Dean Schillinger; John Piette; Kevin Grumbach; Frances Wang; Clifford Wilson; Carolyn Daher; Krishelle Leong-Grotz; Cesar Castro; Andrew B Bindman Journal: Arch Intern Med Date: 2003-01-13
Authors: Kathryn I Pollak; Katrina M Krause; Kimberly S H Yarnall; Margaret Gradison; J Lloyd Michener; Truls Østbye Journal: BMC Health Serv Res Date: 2008-12-01 Impact factor: 2.655
Authors: Linnaea Schuttner; Stacey Hockett Sherlock; Carol E Simons; Nicole L Johnson; Elizabeth Wirtz; James D Ralston; Ann-Marie Rosland; Karin Nelson; George Sayre Journal: J Gen Intern Med Date: 2022-05-23 Impact factor: 6.473