Effectiveness of Electronic Health Record-Based Interventions for Improving Follow-Up in Primary Care
The goal of this proposal is to demonstrate and test methods by which large health care
systems can efficiently identify cancer patients who are more likely to experience
diagnostic delays and pre-emptively rectify these delays. This study will build upon tools
developed in our recent work (Aim1, prior IRB Protocol Number: H-23801) and test their
effectiveness to identify patients at risk of experiencing delays in cancer diagnosis
followed by an intervention that the investigators hypothesize will reduce these delays.
This is Aim 2 (for which the investigators are seeking approval) is the final Aim of this
proposal. Aim 1 was approved under Protocol Number: H-23801.
In Aim 2 the investigators will determine the effectiveness of an IT-based intervention
(consisting of data mining using triggers tested in Aim 1 followed by targeted electronic
communication and surveillance techniques) to facilitate cancer diagnosis as compared with
usual care (no use of trigger or electronic communication and surveillance). Hypothesis 1:
The mean time from first appearance of a diagnostic clue to follow-up action (e.g.
colonoscopy performance after a positive FOBT) will be significantly less in the
intervention arm than in usual care. Hypothesis 2: The proportion of patients receiving
timely follow-up care will be significantly more in the intervention arm than in usual care.
To improve the generalizability of our findings to multiple ambulatory care environments,
the investigators will conduct our research in two settings: an urban Veterans Affairs
facility in Houston, Texas and a large primary care network in central Texas. These settings
include internal medicine and family medicine, academic and nonacademic practices, and
significant racial, gender, ethnic, age, urban/rural, and socioeconomic diversity. Our study
addresses coordination and timeliness of care, both of which are priorities to achieve high
Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Caregiver), Primary Purpose: Health Services Research
Time lag from diagnostic clue indicating the potential for cancer to follow-up action by provider
The median time from first appearance of a diagnostic clue for cancer (e.g. positive FOBT) to follow-up action taken by a treating provider(e.g. colonoscopy performance) in both intervention and control groups.
Hardeep Singh, MD MPH
Baylor College of Medicine
United States: Institutional Review Board
|Scott and White Memorial Hospital||Temple, Texas 76508|
|Michael E. DeBakey VA Medical Center||Houston, Texas 77030|