Evaluation of Computer Generated After Visit Summaries to Support Patient-Centered Care
Trial Snapshot
- Phase
- Phase 3
- Status
- Completed
- Sponsor
- Baylor College of Medicine
- Enrollment
- 272
- Primary Endpoint
- Recall of After Visit Summary Content
Study Overview
Brief Summary
The electronic medical record (EMR) offers a new method to provide patients with information about their visits with a clinician. The EMR can generate personalized and patient specific handouts at the end of the visit that can recap the topics covered during that visit. These After Visit Summaries (AVS) can be automatically generated with information contained in the patient's chart. The AVS has the potential to improve patient retention of information needed for adherence to treatment plans, and follow-up instructions, and to facilitate information transfer between healthcare settings. However, the content and formatting of the AVS to optimize patients' information retention and satisfaction with the visit is not known. In this study, we will develop and test in a randomized trial three different versions of an AVS to determine the AVS content that maximizes patient satisfaction and retention of information on the AVS,and adherence to physician instructions. The three versions of the AVS developed from patient and physician input will be compared to a control condition which consists of current practice in each setting.
Detailed Description
We will conduct an experiment in the four selected primary care clinics to test objectively the effect of three levels of AVS content on patient recall of personal visit information, satisfaction with the information received from their providers, and uses of the information after their visits.
The four clinics were selected to provide a diverse patient sample with regard to socioeconomic status, race/ethnicity and language preference. The study is planned to have a total of 68 patients in each AVS form group (272 total), and 136 patients in each language group. In our previous research in these SPUR-Net clinics, we found that it is very difficult to recruit Spanish-language preference individuals in private practice settings. The great majority of persons of Hispanic ethnicity who attend private practice clinics prefer to communicate in English. For this reason, we will not attempt to recruit Spanish-speakers from the Baylor Family Medicine Clinic. Patients will be approached, and if they agree to participate they will be consented for the study. At the end of the visit, each study patient will be randomized either to the control group or one of the three experimental groups. The RA will accomplish this by opening a sealed envelope that contains the randomly generated group assignment. For the experimental AVS's, the RA will select and generate the appropriate study AVS in Epic. For the control group, the AVS that is currently being used in that clinic will be printed and distributed to the patient. All research subjects will then be contacted in 24 hours, and then again in 2-3 weeks to study the following outcomes.
We are not able to test a control condition that withholds an AVS altogether, in as much as JACHO standards governing some of the participating clinics require an AVS of some kind.
Primary Outcome: The primary outcome measure will be the amount of information recalled by patients at two time points: 2 days after the primary care visit, and 2-3 weeks after the visit. The recall test will consist of two parts. Part 1 will involve recall of the general categories of information contained on the AVS. Sample questions are:
- Did the form have information about your blood pressure?
- Did the form have information about your medications?
- Did the form have a list of your health problems?
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Health Services Research
- Masking
- None
Eligibility Criteria
- Ages
- 21 Years to 99 Years (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Adult 21 or over
- •At least one previous visit to the clinic
- •Has one chronic condition require medications
- •Willing to participate and answer questionnaires by phone
Exclusion Criteria
- •No previous visits to the clinic
- •Unwilling to participate
Arms & Interventions
Maximum AVS Content
AVS includes patient name, visit date, chief complaining, allergies, immunizations, vital signs, medications, problem list, lab order, physician contact information, referrals, instructions
Intervention: Maximum After Visit Summary Content (Other)
Intermediate AVS content
AVS includes patient name, visit date, vital signs, medications, diagnosis, problem list, physician contact information, referrals, instructions
Intervention: Intermediate After Visit Summary Content (Other)
Minimum AVS content
AVS contains patient name, visit date, medications, diagnosis, physician contact information, referrals, instructions
Intervention: Minimum After Visit Summary Content (Other)
Control Group (Usual AVS)
Content differed by clinic site
Intervention: Usual AVS (Other)
Outcomes
Primary Outcomes
Recall of After Visit Summary Content
Time Frame: 2 days post visit
Secondary Outcomes
- Satisfaction with the After Visit Summary(2 days post visit)
Investigators
Valory Pavlik
Associate Professor
Baylor College of Medicine