UNC Eshelman School of Pharmacy and UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Center for Health Policy and Services Research, Henry Ford Health System, Detroit, MI, USA.
Med Decis Making. 2022 Nov;42(8):985-998. doi: 10.1177/0272989X221104094. Epub 2022 Jun 28.
Even after a physician recommendation, many people remain unscreened for colorectal cancer (CRC). The proliferation of electronic health records (EHRs) and tethered online portals may afford new opportunities to embed patient-facing interventions within clinic workflows and engage patients following a physician recommendation for care. We evaluated the effectiveness of a patient-facing intervention designed to complement physician office-based recommendations for CRC screening.
Using a 2-arm pragmatic, randomized clinical trial, we evaluated the intervention's effect on CRC screening use as documented in the EHR (primary outcome) and the extent to which the intervention reached the target population. Trial participants were insured, aged 50 to 75 y, with a physician recommendation for CRC screening. Typical EHR functionalities, including patient registries, health maintenance flags, best practice alerts, and secure messaging, were used to support research-related activities and deliver the intervention to enrolled patients.
A total of 1,825 adults consented to trial participation, of whom 78% completed a baseline survey and were exposed to the intervention. Most trial participants (>80%) indicated an intent to be screened on the baseline survey, and 65% were screened at follow-up, with no significant differences by study arm. One-third of eligible patients were sent a secure message. Among those, more than three-quarters accessed study material.
By leveraging common EHR functionalities, we integrated a patient-facing intervention within clinic workflows. Despite practice integration, the intervention did not improve screening use, likely in part due to portal-based interventions not reaching those for whom the intervention may be most effective.
Embedding patient-facing interventions within the EHR enabled practice integration but may minimize program effectiveness by missing important segments of the patient population.
Electronic health record tools can be used to facilitate practice-embedded pragmatic trial and patient-facing intervention processes, including patient identification, study arm allocation, and intervention delivery.The online portal-embedded intervention did not improve colorectal cancer (CRC) screening uptake following a physician recommendation, likely in part because portal users tend to be already highly engaged with healthcare.Relying on patient portals alone for CRC screening interventions may not alter screening use and could exacerbate well-known care disparities.
即使有医生的推荐，许多人仍然没有接受结直肠癌（CRC）筛查。电子健康记录（EHR）的普及和与之相关联的在线门户可能为在诊所工作流程中嵌入面向患者的干预措施并在医生推荐患者进行护理后与患者接触提供新的机会。我们评估了一种旨在补充医生办公室推荐进行 CRC 筛查的面向患者的干预措施的有效性。
我们使用 2 臂实用随机临床试验，评估了该干预措施对 EHR 中记录的 CRC 筛查使用的影响（主要结果）以及该干预措施达到目标人群的程度。试验参与者有保险，年龄在 50 至 75 岁之间，并有医生推荐进行 CRC 筛查。包括患者登记、健康维护标志、最佳实践警报和安全消息在内的典型 EHR 功能被用于支持与研究相关的活动，并向登记的患者提供干预措施。
共有 1825 名成年人同意参与试验，其中 78%完成了基线调查并接触到了干预措施。大多数试验参与者（>80%）在基线调查中表示有筛查意向，65%在随访时接受了筛查，两组之间无显著差异。三分之一的符合条件的患者收到了安全信息。其中，超过四分之三的人访问了研究材料。
通过利用常见的 EHR 功能，我们将面向患者的干预措施整合到诊所工作流程中。尽管进行了实践整合，但该干预措施并未改善筛查的使用，这可能部分归因于基于门户的干预措施并未覆盖到那些可能最受益的人群。
将面向患者的干预措施嵌入 EHR 中可以实现实践整合，但可能会因错过患者群体的重要部分而降低计划的有效性。
电子健康记录工具可用于促进实践嵌入式实用试验和面向患者的干预措施过程，包括患者识别、研究臂分配和干预措施的提供。在线门户嵌入的干预措施并没有改善医生推荐后的结直肠癌（CRC）筛查率，这可能部分是因为门户用户往往已经高度参与医疗保健。仅依靠患者门户进行 CRC 筛查干预措施可能不会改变筛查使用情况，并可能加剧众所周知的护理差距。
