Functional Assessment Screening Patient Reported Information: FAST-PRI (Utah)

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Summary:

Health care providers play an important role in encouraging healthy behaviors and identifying factors that impact patients’ mental and physical health-related quality of life (HRQoL). Tobacco, physical activity, and poor emotional HRQoL are major causes of morbidity and mortality that are not adequately addressed in current systems of care. While physician involvement can help patients make positive changes in their health behaviors and improve their HRQoL, provider time constraints and limited physician self-efficacy may limit patients’ behavior change.

This project evaluated the Functional Assessment Screening Tablets (FAST) tool, which provides patients with self-management support. FAST is a wirelessly-networked tablet computer that collects patient-reported information (PRI) while patients wait to see their primary care provider. These data are then available to providers at the time of the patient’s visit. The FAST-PRI intervention provides patients with immediate, personalized, guideline-based feedback about tobacco use, physical activity, and mental HRQoL and encourages them to take a more active role in their health.

The specific aims of the project were as follows:

  • Use IT patient feedback regarding study-designated PRI (i.e., tobacco use, physical inactivity, and mental HRQoL) to activate patients. 
  • Assess the impact of FAST patient feedback on study-designated PRI. 
  • Evaluate potential mediators of the effectiveness of FAST patient feedback on study-designated PRI. 

FAST-PRI was evaluated with a randomized controlled trial clustered at the physician level. Patient and physician participants completed questionnaires at baseline, 6 months, and 12 months regarding smoking cessation attempts, physical activity, mental HRQoL, referral to other sources of care, and self-efficacy. FAST-PRI activated patients and prompted more discussions of difficult behavioral health topics between patients and providers; however, the rates of smoking, physical activity, or mental HRQoL did not change. Researchers concluded that future studies may consider allowing patients to directly ask for behaviorist assistance in managing these challenging health care needs.

Functional Assessment Screening Patient Reported Information: FAST-PRI - 2012

Summary Highlights

  • Principal Investigator: 
  • Funding Mechanism: 
    PAR: HS08-270: Utilizing Health Information Technology to Improve Health Care Quality (R18)
  • Grant Number: 
    R18 HS 018932
  • Project Period: 
    August 2012 – July 2015
  • AHRQ Funding Amount: 
    $1,200,000
  • PDF Version: 
    (PDF, 291.29 KB)

Summary: Tobacco, physical activity, and poor mental health-related quality of life (HRQoL) are major causes of morbidity and mortality that are not being adequately addressed by current systems of care. Health care providers are most effective in encouraging healthy behaviors and identifying factors that impact patients’ HRQoL when they partner with informed, motivated, and engaged patients.

The study will be conducted in an academic medical practice which currently uses wirelessly-networked tablet computers, Functional Assessment Screening Tablets (FAST), to collect patient-reported information (PRI) while patients wait to see their primary care provider and makes PRI available to providers at the time of the patient’s visit. This project evaluates a new health information technology (IT)-based tool used in this FAST-PRI intervention to provide patients with immediate, personalized, guideline-based feedback about tobacco use, physical activity, and mental HRQoL, and encourages them to take a more active role in their health.

The project team will conduct a 12-month randomized controlled trial of health IT patient feedback clustered at the physician level. Patients and providers will complete questionnaires regarding discussions of health behaviors and HRQoL at each clinical encounter. In addition, patient participants will complete questionnaires regarding smoking-cessation attempts, physical activity, and mental HRQoL, as well as self-efficacy and use of interdisciplinary referral at baseline, 6, and 12 months. Physicians will be surveyed on self-efficacy at baseline, 12, and 24 months. Referral data on health behaviors, HRQoL, and referrals will be abstracted from the electronic medical record.

Analysis of results will compare the physicians enrolled in the intervention and control arms with respect to training status (resident versus attending physician) and gender to assess imbalances that need to be considered in the analysis testing the intervention’s effects. The team will compare patients in the intervention and control groups based on demographic characteristics such as age, sex, race, and number of medical comorbidities. They will also use demographic characteristics to compare patients in the intervention and control groups who complete the study to those who do not. Finally, the team will compare the impact of health IT patient feedback on changes in patient behavior, accounting for clustering by physician.

Specific Aims:

  • Use health IT patient feedback regarding study-designated PRI (i.e., tobacco use, physical inactivity, and mental HRQoL) to activate patients. (Ongoing)
  • Assess the impact of health IT patient feedback on study-design PRI. (Upcoming)
  • Evaluate potential mediators of the effectiveness of health IT patient feedback on study-designated PRI. (Upcoming)

2012 Activities: Recruitment of clinicians was finalized and the testing of the health IT-based intervention and Web-based surveys was completed for an anticipated go-live date in January 2013. Physician education and resource handouts were completed. In preparation for the trial, physicians were randomized to intervention and control arms and stratified by training status. As last self-reported in the AHRQ Research Reporting System, project progress and activities are on track and the project budget spending is on target.

Preliminary Impact and Findings: The project has no findings to date.

Target Population: Adults, Chronic Care*, Mental Health/Depression

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to improve health care decisionmaking through the use of integrated data and knowledge management.

Business Goal: Implementation and Use

*This target population is one of AHRQ’s priority populations.

Functional Assessment Screening Patient Reported Information: FAST-PRI - Final Report

Citation:
Hess, R. Functional Assessment Screening Patient Reported Information: FAST- PRI - Final Report. (Prepared by University of Pittsburgh under Grant No. R18 HS018932). Rockville, MD: Agency for Healthcare Research and Quality, 2015. (PDF, 366.31 KB)

The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. (Persons using assistive technology may not be able to fully access information in this report. For assistance, please contact Corey Mackison)
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