Impact of Pre-visit Contextual Data Collection on Patient-Physician Communication and Patient Activation: a Randomized Trial

Abstract

Background

Patient contextual data (PCD) are often missing from electronic health records, limiting the opportunity to incorporate preferences and life circumstances into care. Engaging patients through tools that collect and summarize such data may improve communication and patient activation. However, differential tool adoption by race might widen health care disparities.

Objective

Determine if a digital tool designed to collect and present PCD improves communication and patient activation; secondarily, evaluate if use impacts outcomes by race.

Design, Setting, and Participants

A pragmatic, two-armed, non-blinded, randomized controlled trial conducted during 2019 in a primary care setting.

Intervention

The PCD tool (PatientWisdom) invited patients to identify preferences, values, goals, and barriers to care. Patients were randomized to a standard pre-visit email or facilitated enrollment with dedicated outreach to encourage use of the tool.

Main Outcomes and Measures

Outcomes of interest were post-visit patient communication and patient activation measured by the Communication Assessment Tool (CAT) and Patient Activation Measure (PAM), respectively. Outcomes were evaluated using treatment-on-the-treated (TOT) and intention-to-treat (ITT) principles.

Key Results

A total of 301 patients were enrolled. Facilitated enrollment resulted in a five-fold increase in uptake of the PCD tool. TOT analysis indicated that the PCD tool was associated with notable increases in specific CAT items rated as excellent: “treated me with respect” (+ 13 percentage points; p = 0.04), “showed interest in my ideas” (+ 14 percentage points; p = 0.03), “showed care and concern” (+ 16 percentage points; p = 0.02), and “spent about the right amount of time with me” (+ 11 percentage points; p = 0.05). There were no significant pre/post-visit differences in PAM scores between arms (− 4.41 percentage points; p = 0.58). ITT results were similar. We saw no evidence of the treatment effect varying by race in ITT or TOT analyses.

Conclusions and Relevance

The inclusion of PCD enhanced essential aspects of patient-provider communication but did not affect patient activation. Outcomes did not differ by race.

Trial Registration

Clincaltrials.gov identifier: NCT03766841

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Funding

The project described was supported by the National Center for Advancing Translational Sciences, National Institutes of Health (NIH), Award Number (UL1TR001436), Health Resources and Services Administration (HRSA) Award Number (T32HP10030), and the Advancing a Healthier Wisconsin Endowment Award Number (5520480).

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Correspondence to Jeana M. Holt Ph.D., DNP, RN, FNP-BC.

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Conflict of Interest

Bradley Crotty reports being an advisor for Buoy Health. Gregory Makoul reports employment with PatientWisdom, Inc. He did not participate in the analysis of trial data.

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Holt, J.M., Cusatis, R., Winn, A. et al. Impact of Pre-visit Contextual Data Collection on Patient-Physician Communication and Patient Activation: a Randomized Trial. J GEN INTERN MED (2021). https://doi.org/10.1007/s11606-020-06583-7

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KEY WORDS

  • patient contextual data
  • health information technology
  • patient-provider communication
  • patient participation
  • primary health care
  • randomized controlled trial
  • health care disparities