Empowering Black Patients to Take a More Active Role in Their Health Care
Researchers at the University of Pittsburgh School of Medicine tested an intervention intended to empower Black patients to take a more active role in their health care.
At four Pittsburgh health clinics, 379 patients awaiting physician appointments used hand-held computers to answer questions about their health status and the reason for their visit. After the appointment, doctors and patients filled out separate forms to assess the value of the pre-visit questionnaire.
Due to technical problems, many of the completed patient questionnaires failed to capture all patient input when printed out, making it impossible for researchers to assess their role in improving patient/physician communication.
- Most participating patients could easily use a hand-held computer to record demographic information and health care concerns. Sixty-one percent felt the questionnaire should continue to be used.
- In the majority of survey responses, physicians indicated there was not great benefit to the use of the pre-visit questionnaire.
The Robert Wood Johnson Foundation (RWJF) supported this project with a grant of $74,851 from December 2006 through June 2008.
Members of racial or ethnic minorities get poorer quality health care than their White counterparts, even after controlling for income, insurance coverage and medical conditions, according to the Institute of Medicine.
Efforts to eliminate these disparities in the past have generally focused on physician education. However, research suggests that engaging patients in treatment decisions can also improve health outcomes. For example, one study found that physicians provided more thorough diagnostic testing to Black patients who were assertive and explicit about their concerns and desire to know all of their treatment options.
In its 2002 report, "Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care," the IOM recommended implementing patient education programs to increase patient knowledge about how best to access care and participate in treatment decisions.
At the time the grant was made, disparities was one of RWJF's grantmaking portfolios. The aim was to ensure that all Americans have access to quality health care by eliminating the gaps in care experienced by racial and ethnic minorities. Its efforts centered on improving understanding of the multiple factors that lead to racial and ethnic minorities receiving poorer quality care and on working directly with health care systems to improve the quality of care for all patients.
From RWJF's 2006 Annual Report:
To ensure that all Americans get quality health care, we have been focused on finding practical, effective solutions that will help health care systems target racial and ethnic disparities as part of their overall quality improvement efforts.
Researchers at the University of Pittsburgh School of Medicine designed an intervention intended to empower Black patients to take a more active role in their health care, improve their communication with physicians and increase patient and physician satisfaction with the visit.
Project staff conducted the research at four Federally Qualified Health Centers in Pittsburgh. Using a hand-held computer (a "tablet"), 381 patients completed a survey before seeing a physician, with help from the project coordinator where necessary. In addition to questions about age, ethnicity, insurance status and overall health status, the form asked about:
- Smoking and exercise habits
- Concerns about medication
- Reasons for the visit
The completed form was then printed out and attached to the patient's chart and the doctors were expected to review it with their patients.
After the visit, the doctors and patients were asked to fill out separate post-visit questionnaires. In addition to asking explicitly whether the printout had been helpful, the patient post-visit form asked whether seven issues had been covered better than normally: general health, lab and test results, physician referrals, medication problems, smoking, weight problems and exercise.
Thirty doctors filled out 379 post-visit questionnaires that asked whether the form had allowed them to better review nine topics with their patients, including old and new medical issues, lab and test results, health maintenance, medication problems, referral needs and lifestyle habits.
More than half of the patient participants were Black and three-quarters were women. All received a $25 gift certificate from a local grocery store for their participation.
The project experienced significant technical problems "that made the forms not useful at all," according to the project director. Despite a series of trial runs, an undetected programming error caused most of the patient questionnaire to print out blank, or to record "no" answers to all of the questions about specific health problems. Project staff were able to improve the form's accuracy, but ultimately 327 of the 381 patient survey forms did not include answers to at least one of the questions.
In a separate challenge, information technology staff at the medical school initially refused to develop an online system for filling out the forms because of a previous confidentiality breach in which a hacker managed to read computerized patient charts. Eventually, they designed a data-gathering strategy that did not require the forms to be on the university Web site.
In a 2008 report to RWJF and a subsequent interview, researchers noted:
- Most participating patients could easily use a tablet computer to record demographic information and health care concerns. The majority were able to use the device on their own, but some required minor assistance.
- Eighty percent (257 patients) found the computer "satisfactory in helping to communicate concerns to their physicians."
- Sixty-seven percent (246 patients) reported being comfortable using the tablet computers.
- Sixty-one percent (251 patients) felt the health questionnaire should continue to be used.
- Physicians failed to find great benefit in the use of the completed patient questionnaire. Although some physicians found the form too long, others said it was particularly useful in helping with smoking and weight issues.
- Physicians were asked "did the PC printout form enhance the visit?" Of 359 responses received, 128 said "yes" (36 percent).
- Physicians were asked "would you like to continue using this form for each visit." Of 231 responses received, 98 said yes (42 percent).
Because so many of the questionnaires were blank, researchers were unable to assess the ability of patients to communicate with their doctors. No data on clinical outcomes was generated from these questionnaires.
Staff at one of the four Pittsburgh clinics in this study continues to test the voluntary use of a hand-held computer to gather patient information prior to clinic visits.
University of Pittsburgh researchers submitted a proposal to National Institutes of Health (NIH) to study whether having diabetes or hypertension patients complete a computerized questionnaire in the waiting room will positively affect health outcomes.
GRANT DETAILS & CONTACT INFORMATION
Improving Patient-Physician Communication Through Health Information Technology With Tablet Personal Computers
University of Pittsburgh School of Medicine (Pittsburgh, PA)
Dates: December 2006 to June 2008
Donald Bell Middleton, M.D.
Report prepared by: James Wood
Reviewed by: Karyn Feiden
Reviewed by: Marian Bass
Program Officer: Debra J. Perez