Impact Studies in Health Literacy and Patient Activation - PART 5

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Slide 1

The second impact case study focuses on patient access to the electronic medical record.

Slide 2

The research example illustrates the impact of a web-based diabetes program and personal health record on diabetes quality of care.

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The purpose of the study was to evaluate whether patient access to their personal electronic health record could impact glycemic control and other risk factors in patients with diabetes.

Slide 4

Participation in the program required each person to create a user name and password on the web-based health management system and complete a diabetes assessment questionnaire as part of the chronic care management tool. The tool provided participants with an assessment that included a diabetes report card displaying user-specific information on treatment goals, risk-factor management, and screening tests in an easy-to-understand format. The tool also provided each user with a summary of his/her results (from the EHR) for a number of measures including hemoglobin A1c, blood pressure, LDL-cholesterol. The data were stored in the user’s personal EHR and accessible through his/her secure web portal. In addition, the data were delivered electronically to the healthcare provider of each participant and follow-up with the provider was encouraged.

Slide 5

During the six months following web-based diabetes education and goal setting, HbA1C fell significantly from 8 percent to 7.2 percent in the participants, but not in the control the control group.

Slide 8

Is there a digital divide?   In a recent survey of members in a federally qualified health center, 60% reported that they never use the Internet, and another 9% said they rarely use it. This follows data gathered through the National Assessments of Adult Literacy that showed those with below basic literacy rarely use the Internet as a source of information. The best way to reach patients who would most benefit from health literacy initiatives, then, is not through the Internet. But most of the information and tools available are web-based. Health care providers and organizations need to find ways to make this information accessible to those who do not use the Internet.

Slide 9

Patient wellness summaries or personal health records take the information available in electronic health records and can make them available through a secure web portal, or they can also be printed to share with patients who do not use or have access to the Internet.

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What is the patient wellness summary?   A document shared with patient during a primary care visit that draws from the electronic medical record in real time that can include: current and trended data for vitals and lab results current medication list preventive services list care plan

Slide 11

Similar to the research example we just looked at, similar findings came out of pilot testing a paper copy version of a patient wellness summary in a large physician group practice. Feedback from patients and providers showed promising results in that the wellness summary:   Promotes personal responsibility   Serves as visual aid in discussion during the care visit   Provides feedback that shows the impact of treatment interventions   Promotes causal links: “My weight has gone up and so has my blood pressure and my LDL”   Serves as motivator for patients who do not want “OVERDUE” on their list of preventive services   Promotes goal setting and shared decision making: “What do you want to do about this?”

Slide 12

A similar tool, called a patient care report, was developed and studied in a small physician group practice.

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Results of the study again showed that the patient care report engendered a sense of personal responsibility and that patients want to check their numbers during visits with their providers.

Slide 14

The Medical College of Georgia is also studying how access to an electronic personal health record empowers patients. I like this patient comment: “We don't waste a lot of time on history, on how have you been, what have you done? It's more, ‘We had goals and where are you at now with that? How's this working out?’ I feel like my 15 minutes is fully packed, whereas before 10 of it was spent trying to get to where we needed to be.”

Slide 1

Impact Case Study 2 Impact of patient access to electronic medical record

Slide 2

Impact of a Web-Based Diabetes Program and Personal Health Record on Diabetes Quality of Care Johnson JA, Singal R. Impact of a Web-Based Diabetes Program and Personal Health Record on Diabetes Quality of Care. JMCM. 2006;9(2):12-16. Impact Case Study 2 Research Example

Slide 3

The objective was to evaluate the impact of a web-based education program and personal electronic health record (EHR) on glycemic control and risk-factor modification in patients with diabetes in a large employer group. Patients with the diagnosis of diabetes mellitus were identified and given a $15 incentive to participate. Impact Case Study 2 Research Example

Slide 4

Participants’ data (total and LDL-cholesterol, HgA1c, and blood pressure) were imported into the EHR, used in the web-based educational tools, and transmitted electronically to the treating physician. Data were collected at baseline and six months after the program onset. Impact Case Study 2 Research Example

Slide 5

After six months, participants had a significant reduction in HgA1C from 8.0 percent to 7.3 percent (p = 0.039), whereas the control group had an increase in HgA1C. Impact Case Study 2 Research Example

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Total cholesterol also fell during study period in the participant group (187 to 171 mg/dl; p = 0.024) but increased in the control group (188 to 198 mg/dl, p = <0.01). Impact Case Study 2 Research Example

Slide 7

These data suggest that a web-based diabetes education program with feedback on laboratory data and recommended treatment goals can significantly improve glycemic control and cholesterol measurements in patients with diabetes. Impact Case Study 2 Research Example

Slide 8

Percent of people who NEVER obtain health information from the internet: Proficient 12% Intermediate 14% Basic 58% Below Basic 80% National Assessment of Adult Literacy (2003) N=1668, FQHC Member Survey (2008) The Digital Divide?

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Impact Case Study 2 Patient Wellness Summary © Marshfield Clinic

Slide 10

Impact Case Study 2 Patient Wellness Summary A document shared with patient during a primary care visit that draws from the electronic medical record in real time current and trended data for vitals and lab results current medication list preventive services list care plan

Slide 11

Impact Case Study 2 Patient Wellness Summary Engenders sense of personal responsibility Serves as visual aid in discussion Promotes causal links: “My weight has gone up and so has my blood pressure and my LDL” Serves as motivator for patients who do not want “OVERDUE” on their list of preventive services Promotes goal setting and shared decision making: “What do you want to do about this?”

Slide 12

Impact Case Study 2 Patient Wellness Summary Family Physicians of Western Colorado (14-physician practice) Mohler PJ, Mohler NB. Improving chronic illness care: lessons learned in a private practice. Fam Pract Manag. 2005 Nov-Dec;12(10):50-6. http://www.ncbi.nlm.nih.gov/pubmed/16366442

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Impact Case Study 2 Patient Response “Patients like their individual reports, particularly the historical trends they provide. For a significant subset of patients, these reports appear to engender a sense of personal responsibility.” http://www.ncbi.nlm.nih.gov/pubmed/16366442

Slide 14

Impact Case Study 2 Patient Response “We don't waste a lot of time on history, on how have you been, what have you done? It's more, ‘We had goals and where are you at now with that? How's this working out?’ I feel like my 15 minutes is fully packed, whereas before 10 of it was spent trying to get to where we needed to be.” Quote from patient participating in pilot study titled, “Using an Electronic Personal Health Record to Empower Patients with Hypertension.” Medical College of Georgia. Funding provided by AHRQ. http://healthit.ahrq.gov/portal/server.pt/gateway/PTARGS_0_11153_876985_0_0_18/R18%20HS017234_2008_Sodomka_final.pdf

Summary: This presentation is an expanded version of a webinar sponsored by Krames Patient Education. Low health literacy is a barrier to care, and populations with chronic diseases are at higher risk. Research suggests activation may help compensate for lower literacy skill. This series explores effective methods to increase patient activation and to address the needs of patients with low health literacy.

Tags: doug seubert health literacy communication communications activation patient engagement empower

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