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- Title
Personal Health Record implementation in rural primary care: A descriptive exploratory study using RE-AIM framework.
- Authors
Davis, Selena; Smith, Mindy A.; Burton, Lindsay; Rush, Kathy L.
- Abstract
Demand is emerging for personal health records (PHRs), a patient-centric digital tool for engaging in shared decision-making and healthcare data management. This study uses a RE-AIM framework to explore rural patients and providers' perceptions prior to and following implementation of a PHR. Health care providers and their patients were recruited from early-adopter patient medical home clinics and a local patient advisory group. Focus groups were used to explore patient and provider pre-implementation perceptions of PHRs and post-implementation provider perspectives. Patients were invited through participating clinics to use the PHR. An implementation process evaluation was conducted. Multiple methods and data sources were used and included pre-/post-intervention patient surveys, provider interviews, and PHR/EHR administrative data. Both patient and provider focus groups described PHRs as providing a comprehensive health story and enhanced communication. Patients prioritized collection of health promotion data while providers endorsed health-related, clinical data. Both groups expressed the need for managing expectations and setting boundaries on PHR use. The evaluation indicated Reach: 16% of targeted patients participated and an additional 127 patients used the PHR as a tool during the COVID-19 pandemic. Effectiveness: Patient satisfaction with use was neutral, with no significant changes to quality of life, self-efficacy, or patients' activation. Adoption: 44% of eligible clinics participated, primarily those operated publicly versus privately, in smaller communities, and farther from a regional hospital. Implementation: Despite system interoperability expectations, at time of roll out, information exchange standards had not been reached. Additional implementation complications arose from the onset of the pandemic. One clinic on-boarded additional patients resulting in a rapid spike in PHR use. Maintenance: All clinics discontinued PHR within the study period, citing several key barriers to use. RE-AIM offers a valuable process evaluation framework for a comprehensive depiction of impact, and how to drive future success. Interoperability, patient agency and control, and provider training and support are critical obstacles to overcome in PHR implementation. Author summary: In phase one, our research study identified the similarities and differences between patients and primary care providers in Personal Health Record technology use and functionality to guide implementation. In phase two, we used an implementation science framework benefitting from multiple methods, data types, and an extensive set of data points, to conduct an implementation process evaluation. The process evaluation of a Personal Health Record implementation offered a comprehensive depiction of its impact and how and in what ways the intervention worked and didn't. The evaluation described the characteristics of individuals willing to participate (Reach), its success in achieving intended outcomes (Effectiveness), the number and representativeness of settings and individuals initiating use (Adoption), the extent that the intervention was delivered as intended (Implementation), and whether there was continued use of the system beyond the study (Maintenance). Overall, our study enhances understanding of PHR implementation strategies within rural primary care with opportunities of future refinement of PHR implementations and improved implementation outcomes.
- Subjects
HUMAN services programs; FOCUS groups; QUALITATIVE research; RESEARCH funding; PRIMARY health care; PHYSICIANS' attitudes; PRE-tests &; post-tests; SOUND recordings; THEMATIC analysis; CONCEPTUAL structures; MEDICAL records; RURAL conditions; RESEARCH methodology; RESEARCH; PATIENT satisfaction; PATIENTS' attitudes; PATIENT participation
- Publication
PLoS Digital Health, 2024, Vol 3, Issue 6, p1
- ISSN
2767-3170
- Publication type
Article
- DOI
10.1371/journal.pdig.0000537