SMART PHR: Self Management and Reminders With Technology: SMART Appraisal of an Integrated Personal Health Record (PHR)
Study Details
Study Description
Brief Summary
This project seeks to improve health care outcomes in complex patients with cardiovascular disease (CVD) or who are at high risk for developing CVD by promoting patient self-management. This will be accomplished in 4 diverse, large primary care practices through the following 3 aims: (1) develop a patient-specific, active component to an existing electronic PHR directed towards patients with complex illnesses that is designed to reduce the risk of cardiovascular disease, (2) conduct a randomized controlled trial of the effectiveness of passive and active PHRs for improving adherence and clinical outcomes of complex patients in an ambulatory environment, and (3) enumerate the barriers and facilitators to implementation and use of an PHR among providers and patients in an ambulatory setting. To accomplish the aim 1, a users group will be assembled to determine which potential features of an 'active PHR' would be most acceptable and useful to them. To accomplish the 2nd aim, 1,000 patients with complex chronic disease leading to increased cardiovascular risk (i.e., CVD or 2 of the 4 conditions of hypertension (HTN), diabetes mellitus (DM), or hyperlipidemia requiring at least one medication for control) will be randomized to a passive PHR (n=500), or an active PHR (n=500) at 4 sites where the PHR currently is installed and in use. Outcomes to be assessed include improvement in control of risk factors (e.g., blood pressure), frequency of compliance with testing guidelines (e.g., annual dilated retinal exams in DM), and clinical outcomes (e.g., myocardial infarction, hospitalizations). Aim 3 will be accomplished by surveying all participants using the PHR, along with nurses and physicians at the study sites, and by conducting focus groups of PHR participants, nurses, and physicians to determine the most useful features of the PHR and to barriers and facilitators of use.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: SMART PHR Patients receive the active PHR |
Other: SMART PHR
Patient receives an active PHR
|
| Other: Passive PHR Usual PHR Care |
Other: usual care
Usual passive PHR
|
Outcome Measures
Primary Outcome Measures
- improved targeted chronic disease outcomes [1 year]
blood pressure and low density lipoprotein level (LDL) in all patients, and A1C in patients who have diabetes. For patients on medications requiring monitoring of electrolytes and creatinine, we will look at changes in these parameters as well.
Secondary Outcome Measures
- change in value in these outcome measures (lipid levels, blood pressure, and A1c levels) [1 year]
- rates of adherence to diagnostic and therapeutic recommendations [1 year]
Eligibility Criteria
Criteria
Inclusion Criteria:
-
=18, if they have medically complex diseases that increase cardiovascular risk not yet a PHR user
Exclusion Criteria:
- current PHR user life-expectancy of less than 6 months dementia or disability that prevents them from being able to utilize a PHR (such as blindness)
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | UPMC Primary Care practices | Pittsburgh | Pennsylvania | United States | 15213 |
Sponsors and Collaborators
- University of Pittsburgh
- Agency for Healthcare Research and Quality (AHRQ)
Investigators
- Principal Investigator: Mark S Roberts, MD, MPP, University of Pittsburgh
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- HS018167