Opportunities and Challenges When Using the Electronic Health Record for Practice-Integrated Patient-Facing Interventions: The e-Assist Colon Health Randomized Trial

Jennifer Elston Lafata, Deirdre A. Shires, Yongyun Shin, Susan Flocke, Kenneth Resnicow, Morgan Johnson, Ellen Nixon, Xinxin Sun and Sarah Hawley
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Jennifer Elston Lafata: UNC Eshelman School of Pharmacy and UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
Deirdre A. Shires: School of Social Work, Michigan State University, East Lansing, MI, USA
Yongyun Shin: School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
Susan Flocke: School of Medicine, Oregon Health and Science University
Kenneth Resnicow: School of Public Health, University of Michigan, Ann Arbor, MI, USA
Morgan Johnson: UNC Eshelman School of Pharmacy, University of North Carolina, at Chapel Hill, Chapel Hill, NC, USA
Ellen Nixon: Center for Health Policy and Services Research, Henry Ford Health System, Detroit, MI, USA
Xinxin Sun: School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
Sarah Hawley: School of Medicine, University of Michigan, Ann Arbor, MI, USA

Medical Decision Making, 2022, vol. 42, issue 8, 985-998

Abstract: Background 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. Design 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. Results 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. Conclusions 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. Implications Embedding patient-facing interventions within the EHR enabled practice integration but may minimize program effectiveness by missing important segments of the patient population. Highlights 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.

Keywords: colorectal cancer screening; hierarchical generalized linear models; patient portals; program reach (search for similar items in EconPapers)
Date: 2022
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Persistent link: https://EconPapers.repec.org/RePEc:sae:medema:v:42:y:2022:i:8:p:985-998

DOI: 10.1177/0272989X221104094

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