Development of an Electronic Medical Record-Integrated Enhanced After-Visit Summary (New York)

Summary:

Patients receive an after-visit summary (AVS) after a clinical encounter to inform them of key clinical, illness self-management, and followup and referral information. Federal regulations and incentives, including Meaningful Use and Patient-Centered Medical Home initiatives, are leading to greatly expanded use of the AVS. While the goal of promoting the AVS is to achieve greater patient-centeredness, many have high reading grade levels, great variation in content and order of items, and variable understandability and usability. The Institute of Medicine recently reported that research is needed to improve the design of the AVS to achieve its potential as a patient information and educational tool.

The overall objective of this study is to develop and pilot test an electronic medical record (EMR)-integrated enhanced after-visit summary (eAVS) that will incorporate evidence-based strategies for communicating printed health information to maximize comprehension and usability of the document.

The specific aims of the project are as follows:

Develop and refine a patient-centered eAVS that is easy for clinicians to use and contains patient-centered information that is understandable and actionable by patients and caregivers, including those with low health literacy
Pilot test the eAVS to assess the experience of patients and providers, process, and impact on patients’ understanding of their medication regimens, medication adherence, and appointment keeping.

The project team will conduct qualitative interviews with medical directors from advanced primary care practices throughout the United States to learn about the features of their AVS and the features that work well and those that do not, as well as conduct focus groups with patients, clinicians, and clinical staff. This qualitative data will inform the design of the eAVS and its integration into the EMR. The project team will then conduct a cluster randomized controlled trial in four primary care practices to compare outcomes using the eAVS and the standard AVS currently in use.

Grant Number:

R21 HS023844

Funding Mechanism:

Exploratory and Developmental Grant to Improve Health Care Quality through Health Information Technology (IT) (R21)

AHRQ Funded Amount:

$300,000

Principal Investigator:

Federman, Alex D.

Organization:

Icahn School Of Medicine At Mount Sinai

City:

New York