New project to assess the effectiveness of visit information provided to older patients

A Dartmouth-led research group, including investigators from Vanderbilt University Medical Center (VUMC), University of Texas Medical Branch (UTMB) at Galveston, and Harvard Medical School, has received a five-year, $7 million funding award from the Patient-Centered Outcomes Research Institute (PCORI). Their project will assess the effectiveness of visit information provided to older adult patients and caregivers-;as an audio recording compared to reviewing the physician note of the visit using the patient electronic health portal-;on quality of life.

PCORI is an independent, non-profit organization authorized by Congress in 2010 with the mission of funding research that will provide patients, their caregivers, and clinicians with the evidence-based information they need to make better-informed healthcare decisions.

In the U.S., older adults attend more than 280 million office visits per year. The information exchanged in these visits guides the course of each person's care-; ensuring that this is effectively communicated is of great importance to patients and caregivers, especially for more vulnerable patients who are trying to manage multiple comorbidities.

"Providing written summaries of office visits through online patient portals is a widely adopted approach to close this information gap," explains Principal Investigator Paul Barr, PhD, an associate professor of The Dartmouth Institute for Health Policy & Clinical Practice, and Center for Technology & Behavioral Health at the Geisel School of Medicine, who leads a talented multisite investigative team with Kerri Cavanaugh, MD, MHS (associate professor and director of the Vanderbilt Center for Effective Health Communication, Vanderbilt University Medical Center), Meredith Masel, PhD, MSW (assistant professor and director of the Oliver Center for Patient Safety & Quality Healthcare, University Texas Medical Branch, Galveston) and Cait DesRoches, DrPH (associate professor, executive director of OpenNotes, Beth Israel Deaconess Medical Center, Harvard Medical School). For a full list of investigators, visit OpenRecordings -CHRONICLE.

But it hasn't been clear if this is the best way to share information. Visit audio recordings have emerged as another evidence-based strategy to share information. This has resulted in a decisional dilemma for patients and healthcare leaders who ask the question, 'What is the most effective approach to communicate healthcare visit information to older adults living in the community?'"

Paul Barr, PhD, associate professor, The Dartmouth Institute for Health Policy & Clinical Practice, and Center for Technology & Behavioral Health at the Geisel School of Medicine

To help them make that determination, the investigators will conduct the CHRONICLE Trial (Comparing Healthcare visit Recording and Open Notes to Improve the Chronic Illness Care Experience for Older Adults). In this trial, 900 older adults (65 years of age or older) with multimorbidity will be randomized to receive clinic provider notes through the patient portal alone or notes along with visit audio recordings for all primary care visits in a six-month period.

The research team also consists of an active group of patient partners who identified the need for the trial, "This project is very important to me in that I fall into the group that this project targets. With the medical issues I have, and the memory problems that result from some of them, finding ways to better access information from doctor visits is vital," says Sheryl Piper, patient partner.

This group, along with other key stakeholders will be actively engaged in all aspects of the trial. "It's really satisfying to give voice to how a patient perceives it [research] in the drawing board stages-;sometimes it all looks good until the patient sees it! I like that my voice influences the research," says Roger Arend, another patient partner.

"Along with our research team, Drs. Cavanaugh, Masel, and I have refined our visit audio recording procedures in recent trials and plan to recruit one-third of the patients to each of our sites-;Dartmouth Health, VUMC, and UTMB. We are excited to work with Dr. DesRoches, who with the OpenNotes group will provide expertise in accessing and using the information within the electronic patient portal during the trial," says Barr.

The investigators also aim to recruit about 300 caregivers under the project to see how they may use recordings to help them care for their loved ones. "Approximately 42 million Americans provide care for an older adult, typically a family member. Our inclusion of caregivers will allow us to address the identified gap in understanding how effective communication of visit information supports caregivers," says Masel.

"Knowledge gained from our study will improve the quality of evidence about the best strategy of communicating vital healthcare information in this vulnerable older adult patient population at high risk for adverse outcomes and lower quality of life," says Cavanaugh.

"There is high potential for the study findings to be adopted into clinical practice and transform delivery of healthcare," Barr says, "and I think our diverse team of patient partners, stakeholders, and investigators is uniquely positioned to attain that goal."

Dr. Barr's study was selected through a PCORI funding announcement specifically focused on comparative clinical effectiveness research that aims to optimize the physical and mental functioning of community-dwelling older adults and their caregivers across the aging continuum. Many older adults live with chronic health conditions and family and friends often serve as primary caregivers to aging individuals. Currently, the healthcare system is not well-equipped to address these complex care needs of the rapidly growing and diverse older adult population in the United States.

"This study was selected for PCORI funding for its potential to answer the need for real-world comparative clinical effectiveness research across the aging continuum that could inform evidence-based clinical practice for this important population," says PCORI Executive Director Nakela Cook, MD, MPH. "We look forward to following the study's progress and working with the Geisel research team to share the results."

Dr. Barr's award has been approved pending completion of a business and programmatic review by PCORI staff and the issuance of a formal award contract.