背景:美国约有1400万人有资格进行肺癌筛查(LCS),但在2021年只有5.8%的人完成了筛查。考虑到低摄取,尽管LCS潜在的巨大健康益处,旨在增加吸收的干预措施是必要的。使用面向患者的电子健康记录(EHR)患者门户直接消息传递工具为使符合条件的患者参与预防性筛查提供了新的机会,并为烟草治疗提供了独特的转诊途径。
目的:本研究旨在开发和试点面向EHR患者的自我转诊工具,用于在学术医学中心建立的LCS计划。
方法:以与LCS摄取相关的健康信念模型的构建为指导(例如,知识和自我效能感),EHR传递的参与信息的形成性发展,信息图,并进行了自我推荐调查。调查将合格的自我报告的患者信息提交给LCS计划的调度程序。使用面试官管理的混合方法调查对材料进行了预先测试,该调查是通过在5个网络附属的肺科诊所中进行的场地日采样进行的。然后将材料集成到EHR系统中的安全患者消息功能中。接下来,进行了一组测试后质量改进试点测试。
结果:共有17名参加肺筛查的参与者完成了预测试调查。一半以上是LCS的新转诊(n=10,60%),剩下的是返回的病人。当被问及他们是否会通过他们的EHR消息门户使用自我参考工具时,94%(n=16)报告是。在它,15名参与者提供了口头反馈,从而在试点测试之前完善了工具和信息图。当将该工具的初始应用发送到150名随机患者的便利样本时,13%(n=20)打开了自我参照调查。在完成试点调查的20人中,根据自我报告的吸烟数据,45%(n=9)符合LCS的条件。共有3名自我推荐的人安排了LCS。
结论:初步和初步应用数据表明,该工具是一个积极的刺激因素,可以触发决策过程,在符合条件的患者中进行LCS的自我转诊过程。这种自我转诊工具可以增加参与LCS的患者数量,也可以用于帮助自我转诊到其他预防性健康检查。该工具对临床实践有影响。烟草治疗临床服务或医疗保健系统应考虑使用EHR消息传递进行LCS自我转诊。这种方法对于改善LCS的参与和吸收可能具有成本效益。该EHR工具可以内置其他转诊途径,不仅可以将目前吸烟的患者转诊至LCS,还可以同时触发转诊至临床烟草治疗。
BACKGROUND: Approximately 14 million individuals in the United States are eligible for lung cancer screening (LCS), but only 5.8% completed screening in 2021. Given the low uptake despite the potential great health benefit of LCS, interventions aimed at increasing uptake are warranted. The use of a patient-facing electronic health record (EHR) patient portal direct messaging tool offers a new opportunity to both engage eligible patients in preventative screening and provide a unique referral pathway for tobacco treatment.
OBJECTIVE: This study sought to develop and pilot an EHR patient-facing self-referral tool for an established LCS program in an academic medical center.
METHODS: Guided by constructs of the Health Belief Model associated with LCS uptake (eg, knowledge and self-efficacy), formative development of an EHR-delivered engagement message, infographic, and self-referring survey was conducted. The survey submits eligible self-reported patient information to a scheduler for the LCS program. The materials were pretested using an interviewer-administered mixed methods survey captured through venue-day-time sampling in 5 network-affiliated pulmonology clinics. Materials were then integrated into the secure patient messaging feature in the EHR system. Next, a one-group posttest quality improvement pilot test was conducted.
RESULTS: A total of 17 individuals presenting for lung screening shared-decision visits completed the pretest survey. More than half were newly referred for LCS (n=10, 60%), and the remaining were returning patients. When asked if they would use a self-referring tool through their EHR messaging portal, 94% (n=16) reported yes. In it, 15 participants provided oral feedback that led to refinement in the tool and infographic prior to pilot-testing. When the initial application of the tool was sent to a convenience sample of 150 random patients, 13% (n=20) opened the self-referring survey. Of the 20 who completed the pilot survey, 45% (n=9) were eligible for LCS based on self-reported smoking data. A total of 3 self-referring individuals scheduled an LCS.
CONCLUSIONS: Pretest and initial application data suggest this tool is a positive stimulus to trigger the decision-making process to engage in a self-referral process to LCS among eligible patients. This self-referral tool may increase the number of patients engaging in LCS and could also be used to aid in self-referral to other preventative health screenings. This tool has implications for clinical practice. Tobacco treatment clinical services or health care systems should consider using EHR messaging for LCS self-referral. This approach may be cost-effective to improve LCS engagement and uptake. Additional referral pathways could be built into this EHR tool to not only refer patients who currently smoke to LCS but also simultaneously trigger a referral to clinical tobacco treatment.