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Randomized Trial of an Electronic Personal Health Record for Patients With Serious Mental Illnesses
Benjamin G. Druss, M.D., M.P.H.; Xu Ji, M.S.P.H.; Gretl Glick, B.A.; Silke A. von Esenwein, Ph.D.
Am J Psychiatry 2014;171:360-368. doi:10.1176/appi.ajp.2013.13070913
View Author and Article Information

The authors report no financial relationships with commercial interests.

Funded by a grant (R18HS017829) from the Agency for Healthcare Research and Quality.

From the Rollins School of Public Health and the Department of Health Policy and Management, Emory University, Atlanta.

Address correspondence to Dr. Druss (bdruss@emory.edu).

Copyright © 2014 by the American Psychiatric Association

Received July 12, 2013; Revised September 25, 2013; Accepted October 25, 2013.

Abstract

Objective  The authors evaluated the effect of an electronic personal health record on the quality of medical care in a community mental health setting.

Method  A total of 170 individuals with a serious mental disorder and a comorbid medical condition treated in a community mental health center were randomly assigned to either a personal health record or usual care. One-year outcomes assessed quality of medical care, patient activation, service use, and health-related quality of life.

Results  Patients used the personal health record a mean of 42.1 times during the 1-year intervention period. In the personal health record group, the total proportion of eligible preventive services received increased from 24% at baseline to 40% at the 12-month follow-up, whereas it declined in the usual care group, from 25% to 18%. In the subset of patients with one or more cardiometabolic conditions (N=118), the total proportion of eligible services received improved by 2 percentage points in the personal health record group and declined by 11 percentage points in the usual care group, resulting in a significant difference in change between the two groups. There was an increase in the number of outpatient medical visits, which appeared to explain many of the significant differences in the quality of medical care.

Conclusions  Having a personal health record resulted in significantly improved quality of medical care and increased use of medical services among patients. Personal health records could provide a relatively low-cost scalable strategy for improving medical care for patients with comorbid medical and serious mental illnesses.

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FIGURE 1. My Health Record Screenshot

FIGURE 2. Study CONSORT Diagram

FIGURE 3. Personal Health Record and Rate of Receipt of Indicated Preventive Care Services
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TABLE 1.Demographic and Clinical Characteristics of the Study Samplea
Table Footer Note

a For continuous variables, a t test was used, and a chi-square test was used for dichotomous variables.

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TABLE 2.Quality of Preventive and Cardiometabolic Care
Table Footer Note

a The data represent the values for group type (personal health record compared with usual care), the key independent variable of interest, without adjusting for the number of outpatient medical visits.

Table Footer Note

b The data indicate the proportion of services for which a participant was eligible and obtained.

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TABLE 3.Service Use, Patient Activation, and Health-Related Quality of Life
Table Footer Note

a The data represent the values for group type (personal health record compared with usual care), the key independent variable of interest.

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TABLE 4.Quality of Preventive and Cardiometabolic Care (Mediation Analysis)
Table Footer Note

a The data represent the coefficient of group type (personal health record compared with usual care).

Table Footer Note

b The values for group type are presented.

Table Footer Note

c The data indicate the proportion of services for which a participant was eligible and obtained.

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