Community Input on an Enhanced Care Planning Tool Addressing Health Behaviors, Mental Health Needs, and Social Risks

Background: Many patients with multiple chronic conditions (MCC) have social risks, mental health needs, and/or unhealthy behaviors. These interfere with their ability to manage their MCC. A care planning tool was created to help address these needs; this study solicited feedback from stakeholder groups and incorporated it into improving the tool. Methods: Instrument: The Enhanced Care Planning (ECP) tool screens patients for social risks, mental health needs, and unhealthy behaviors. They are shown where their responses revealed risk, then select 1-2 to improve upon. Next, patients set personal goals and select strategies to support them. Patients are supported by the clinical care team and a community health worker to connect them to community resources. Procedures: Four stakeholder groups provided feedback on the ECP tool: community members, community service professionals (CSPs), researchers, and patients. A community review board of community members reviewed the ECP process. Researchers and CSPs then reviewed ECP content. Feedback was incorporated into revisions of the ECP content and process, then patients provided final feedback. Results: All stakeholder groups provided unique feedback. Community members desired visuals, the ability to individualize and receive support throughout the process. Researchers and CSPs recommended removing jargon. While researchers were interested in specific evidence-based strategies, CSPs suggested strategies with anecdotal support. Patients expressed positive overall impressions of the tool, interest in using it, and increased awareness of domains that influence their health. Conclusion: Feedback from all groups significantly altered the ECP tool’s design, and is likely to improve its usability and impact.https://scholarscompass.vcu.edu/gradposters/1109/thumbnail.jp

Harnessing Information Technology to Inform Patients Facing Routine Decisions: Cancer Screening as a Test Case

PURPOSE Technology could transform routine decision making by anticipating patients’ information needs, assessing where patients are with decisions and preferences, personalizing educational experiences, facilitating patient-clinician information exchange, and supporting follow-up. This study evaluated whether patients and clinicians will use such a decision module and its impact on care, using 3 cancer screening decisions as test cases. METHODS Twelve practices with 55,453 patients using a patient portal participated in this prospective observational cohort study. Participation was open to patients who might face a cancer screening decision: women aged 40 to 49 who had not had a mammogram in 2 years, men aged 55 to 69 who had not had a prostate-specific antigen test in 2 years, and adults aged 50 to 74 overdue for colorectal cancer screening. Data sources included module responses, electronic health record data, and a postencounter survey. RESULTS In 1 year, one-fifth of the portal users (11,458 patients) faced a potential cancer screening decision. Among these patients, 20.6% started and 7.9% completed the decision module. Fully 47.2% of module completers shared responses with their clinician. After their next office visit, 57.8% of those surveyed thought their clinician had seen their responses, and many reported the module made their appointment more productive (40.7%), helped engage them in the decision (47.7%), broadened their knowledge (48.1%), and improved communication (37.5%). CONCLUSIONS Many patients face decisions that can be anticipated and proactively facilitated through technology. Although use of technology has the potential to make visits more efficient and effective, cultural, workflow, and technical changes are needed before it could be widely disseminated

Practice facilitation to promote evidence-based screening and management of unhealthy alcohol use in primary care: a practice-level randomized controlled trial

Background Unhealthy alcohol use is the third leading cause of preventable death in the United States. Evidence demonstrates that screening for unhealthy alcohol use and providing persons engaged in risky drinking with brief behavioral and counseling interventions improves health outcomes, collectively termed screening and brief interventions. Medication assisted therapy (MAT) is another effective method for treatment of moderate or severe alcohol use disorder. Yet, primary care clinicians are not regularly screening for or treating unhealthy alcohol use. Methods and analysis We are initiating a clinic-level randomized controlled trial aimed to evaluate how primary care clinicians can impact unhealthy alcohol use through screening, counseling, and MAT. One hundred and 25 primary care practices in the Virginia Ambulatory Care Outcomes Research Network (ACORN) will be engaged; each will receive practice facilitation to promote screening, counseling, and MAT either at the beginning of the trial or at a 6-month control period start date. For each practice, the intervention includes provision of a practice facilitator, learning collaboratives with three practice champions, and clinic-wide information sessions. Clinics will be enrolled for 6–12 months. After completion of the intervention, we will conduct a mixed methods analysis to identify changes in screening rates, increase in provision of brief counseling and interventions as well as MAT, and the reduction of alcohol intake for patients after practices receive practice facilitation. Discussion This study offers a systematic process for dissemination and implementation of the evidence-based practice of screening, counseling, and treatment for unhealthy alcohol use. Practices will be asked to implement a process for screening, counseling, and treatment based on their practice characteristics, patient population, and workflow. We propose practice facilitation as a robust and feasible intervention to assist in making changes within the practice. We believe that the process can be replicated and used in a broad range of clinical settings; we anticipate this will be supported by our evaluation of this approach