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The Role of Health Information Technology in the Translation of Research into Practice: An Oklahoma Physicians Resource/Research Network (OKPRN) Study

Zsolt Nagykaldi and James W. Mold
The Journal of the American Board of Family Medicine March 2007, 20 (2) 188-195; DOI: https://doi.org/10.3122/jabfm.2007.02.060084

Article Figures & Data

Figures

  • Figure 1.
    Figure 1.

    Preventive Services Reminder System (PSRS) workflow in a paper-based large academic family residency practice. PSRS was incorporated into the existing office workflow, and new tasks associated with PSRS were assigned to members of the clinic team. Nurse empowerment in the form of standing orders was a critical step in the process. Although delivery of preventive services significantly improved, PSRS increased the staff’s workload.

  • Figure 2.
    Figure 2.

    Preventive Services Reminder System (PSRS) workflow in a middle-sized suburban family practice. A physician-centered protocol was developed to implement PSRS. The nurse and occasionally the office staff assisted the physician to deliver and document services. PSRS was effective but resulted in additional work for the clinician and the staff.

  • Figure 3.
    Figure 3.

    Preventive Services Reminder System (PSRS) workflow in a rural solo physician practice. A prevention station was established with the help of a full-time dedicated prevention/wellness nurse. Preventive services were separated from the regular daily workflow and managed by the wellness nurse with the help of PSRS. The nurse proactively ran electronic chart audits, recalled patients, negotiated a wellness plan, and delivered services based on standing orders.

  • Figure 4.
    Figure 4.

    Advanced preventive services delivery model based on a health risk appraisal-driven prioritization of tasks. The risk engine generates an evidence-based prioritized list of recommendations that is turned into a wellness plan negotiated with the patient. The plan is then entered into a task management system and a wellness nurse carries out the plan in a timely manner. HRA, health risk appraisal; EHR, electronic health record; CCR, Continuity of Care Record.

Tables

  • Table 1.

    Preventive Services Reminder System (PSRS) Study No. 1: Coverage Rates of Preventive Services before and after PSRS Implementation in Intervention and Control Practices

    Adult Diabetics and 2- to 3-year oldsHepB#3DTaP#4MMR#1PCV#3Smoking StatusSmoking CounselingAdult Pneumococcal
    Intervention
        Pre78%68%86%30%66%23%39%
        Post93%86%93%38%93%78%78%
        P (n = 3).0005.001.0005NS.02.0004.0003
    Control
        Pre64%57%64%29%75%6%33%
        Post61%53%61%27%70%13%33%
        P (n = 3)NSNSNSNSNSNSNS

    • Pre and post, before and after implementation; NS, not significant difference; HepB#3, third dose of hepatitis B vaccine; DtaP#4, fourth dose of diphtheria, tetanus, and pertussis vaccine; MMR#1, measles, mumps, and rubella vaccine.

  • Table 2.

    Preventive Services Reminder System (PSRS) Study No. 2: Coverage Rates of Preventive Services before and after PSRS Implementation in Intervention and Control Practices

    2- to 3-year oldsHepB#3DTaP#4IPV#3Hib#4MMR#1PCV#3EPSDT (24 mo)
    Intervention
        Pre48%28%48%29%47%19%27%
        Post78%70%80%53%73%28%38%
        P (n = 6).012.003.019.011.021.113.055
    Control
        Pre75%69%75%51%77%29%33%
        Post71%65%71%55%75%43%30%
        P (n = 6)0.6310.3670.4460.3770.6290.1900.271
    52- to 74-year oldsAdult dTAdult PneumoFlu ShotSmoking StatusSmoking Counsel.MammographyColon Cancer Screening
    Intervention
        Pre15%21%30%61%29%23%16%
        Post19%27%30%74%78%55%27%
        P (n = 6).190.051.303.141.026.010.058
    Control
        Pre22%38%49%82%80%42%25%
        Post23%35%34%72%71%35%19%
        P (n = 5).805.707.208.460.356.536.864

    • Pre and post, before and after implementation; HepB#3, third dose of hepatitis B vaccine; DTaP#4, fourth dose of diphtheria, tetanus, and pertussis vaccine; IPV#3, inactivated poliovirus vaccine; Hib#4, fourth dose of haemophilus influenzae vaccine; MMR#1, measles, mumps, and rubella vaccine; EPSDT, well child visit.

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