AHRQ offers lessons and models from patient-centered IT pilots
The Agency for Healthcare Research and Quality (AHRQ) is sharing findings and lessons from a series of patient-centered care and health IT pilot projects, covering quality measurements, risk assessments, patient portals and complex disease management models.
The AHRQ funded 16 projects across the country in 2007, from a $6 million grant program, and the results show the growth of clinician- and patient-tailored apps that blend telemedicine and traditional care — home-based reminder systems for diabetics, web-based self check ups for hypertension, internet-linked sleep apnea devices and other patient-centered technologies.
AHRQ says the findings especially show the potential benefits of interventions in vulnerable populations and the integration of information across transitions of care. And as physicians especially gird for oncoming meaningful use stages, several pilots showed some evolving clinician preferences for tablet computers.
At the Milwaukee VA Medical Center Medical College of Wisconsin professor Edith Burns, MD, an internist and geriatric specialist, developed a home-based reminder and feedback system for diabetic patients. With software program and glucometer interface installed on a patient's PC, he or she receive audio prompts for testing and medications, along with feedback based on glucose results, with guidance from a primary care doc.
Following about 170 patients who used the device for 15 months and a control group, the study did not find an overall large impact on blood glucose levels for those with diabetes, but frequent users did see larger reductions in blood glucose levels than infrequent users, and regular users who had been diabetic for more than a decade ended up spending fewer hours in sedentary behavior at the end of 15 months.
In Philadelphia, Temple University cardiologist Alfred Bove, MD, and colleagues created a hypertension monitoring system using both web and telephone platforms with asymptomatic patients, primarily from low-income urban communities. Over the course of 6 months, 242 patients reported blood pressure, heart rate, weight, steps per day and smoking status twice a week via the web or phone, and a research team responded to patient input depending on their condition and coordinated the results or needed care with primary care physicians.
The study found hypertension patients using the web/phone system had an average reduction in diastolic blood pressure of 18 mmHg, while non-diabetes patients tended to fare better than those with hypertension and diabetes.
At Massachusetts General Hospital, a team led by informaticist Henry Chueh, MD, built an app add-on to the health system’s primary care ambulatory EHR that automatically monitors care plans for colorectal cancer screening, abnormal radiology results and new medications that require follow up testing, notifying both patients and providers of needed actions as part of their care plans.
Virginia Commonwealth University family medicine professor Alex Krist, MD, created a PHR giving patients direct access to information in their clinician’s EHR, displaying any of 573 tailored recommendations and reminders for 18 clinical preventive services, based on a risk assessment completed by the patient. It also provides primary care practices with a PHR-generated summary.
Krist and his colleagues wanted to test what they dubbed an interactive preventive health record (IPHR) and whether it increases the delivery of recommended preventive services. Studying about 700 patients, they found that PHR users were more up to date with preventive services recommendations than a control group, and a subgroup of IPHR users targeted for intervention saw preventive colorectal, breast, and cervical cancer screenings and pneumococcal vaccination increased by 12.3 to 16 percent.
At eight primary care practices in Oklahoma, internist James Mold, MD, and colleagues at the University of Oklahoma created a wellness PHR, for patients to manage preventive services history, risk factor and tailor their own plans. The PHR reminded patients to update their records, complete a health risk appraisal before annual wellness visits and discuss the wellness report with their doctor, and part of the idea was to probe both patient and clinician experience of the PHRs.
As most patients reported a positive experience with the final PHR interface, clinicians largely rejected the first version of the PHR, a full-size kiosk in the waiting room, “finding it too intimidating and conspicuous for private medical information.” The researchers replaced the kiosk with touch-screen tablets, which were more readily embraced.