Engaging Primary Care Patients to Use a Patient-Centered Personal Health Record

作者：Krist Alex H^*; Woolf Steven H; Bello Ghalib A; Sabo Roy T; Longo Daniel R; Kashiri Paulette; Etz Rebecca S; Loomis John; Rothemich Stephen F; Peele J Eric; Cohn Jeffrey

来源：Annals of Family Medicine, 2014, 12(5): 418-426.

DOI：10.1370/afm.1691

• personal health records
• informatics
• primary health care
• patient-centered care
• health promotion

PURPOSE Health care leaders encourage clinicians to offer portals that enable patients to access personal health records, but implementation has been a challenge. Although large integrated health systems have promoted use through costly advertising campaigns, other implementation methods are needed for small to medium-sized practices where most patients receive their care. %26lt;br%26gt;METHODS We conducted a mixed methods assessment of a proactive implementation strategy for a patient portal (an interactive preventive health record [IPHR]) offered by 8 primary care practices. The practices implemented a series of learning collaboratives with practice champions and redesigned workflow to integrate portal use into care. Practice implementation strategies, portal use, and factors influencing use were assessed prospectively. %26lt;br%26gt;RESULTS A proactive and customized implementation strategy designed by practices resulted in 25.6% of patients using the IPHR, with the rate increasing 1.0% per month over 31 months. Fully 23.5% of IPHR users signed up within 1 day of their office visit. Older patients and patients with comorbidities were more likely to use the IPHR, but blacks and Hispanics were less likely. Older age diminished as a factor after adjusting for comorbidities. Implementation by practice varied considerably (from 22.1% to 27.9%, P %26lt;.001) based on clinician characteristics and workflow innovations adopted by practices to enhance uptake. %26lt;br%26gt;CONCLUSIONS By directly engaging patients to use a portal and supporting practices to integrate use into care, primary care practices can match or potentially surpass the usage rates achieved by large health systems.

• 出版日期2014-10