Results Summary
What was the research about?
Often, patients and doctors don’t have enough time during healthcare visits to talk about all of a patient’s concerns. Helping patients prepare for their visits may improve the quality of care.
In this study, the research team created a visit planner to help new patients and patients with more than one long-term health problem prepare for their visits. The tablet-based planner, which was available in English or Spanish, helped patients identify their top concerns before their visits and understand the care plan after their visits. The team compared patients who received the visit planner with those who didn’t and looked at
- Closing care gaps, which are tests and treatments, such as blood sugar testing, that patients need to improve their health but haven’t received yet
- Improving care quality, such as communication quality and satisfaction with care
What were the results?
After six months, patients in the two groups didn’t differ in closure of care gaps. Compared with patients who didn’t receive the visit planner, those who did were more likely to say they
- Prepared questions for their doctors
- Told their doctors about their top concerns at the start of their visits
The two groups didn’t differ in how often patients
- Were satisfied with their care
- Were offered treatment choices
- Were asked about their ideas and goals for their care
- Took medicine as directed by their doctors
- Attended follow-up visits
Who was in the study?
The study included 750 patients who had at least two long-term health problems or who had a new patient visit. All patients received care at a healthcare system in California. Of these patients, 38 percent were white, 28 percent were African American, 22 percent were Hispanic, and 7 percent were Asian. The average age was 61, and 65 percent were women.
What did the research team do?
The research team assigned doctors by chance to one of two groups. The team then assigned each doctor’s eligible patients to the same group as the doctor. In the first group, patients completed the visit planner in the waiting room. These patients brought a summary of their plan to their visits. In the second group, patients received a healthy lifestyle information sheet. Patients in both groups received their usual care from their doctors.
To identify care gaps, the research team reviewed patients’ health records. They looked at what tests and treatments patients needed to receive at the start of the study and monthly for six months, and what care they did receive. Patients took surveys about care quality by phone within two weeks of their visits.
A group of patients, community members, and doctors helped design the visit planner and gave input during the study.
What were the limits of the study?
The care gaps identified in the health records may not have been the same as patients’ top concerns for their visits. Patients with long-term health problems received extra care from nurses and others, which may have affected the study results.
Future research could explore ways to address patients’ top concerns during visits and find out whether addressing these concerns leads to improved health and care quality.
How can people use the results?
Healthcare clinics can use these results when considering ways to improve patients’ visits.
Professional Abstract
Objective
To assess the effectiveness of a tablet-based visit planner in improving healthcare visit interactions and quality of care among patients who either had multiple chronic conditions or who were new to their primary care physicians
Study Design
| Design Element | Description |
|---|---|
| Design | Randomized controlled trial |
| Population | 750 patients who either had multiple chronic conditions or who were new to their primary care physicians |
| Interventions/ Comparators |
|
| Outcomes |
Primary: clinical care gap closure, patient-reported care quality (satisfaction with care, treatment autonomy, perceived patient-centeredness of visit, quality of communication) Secondary: treatment adherence, follow-up visit attendance |
| Timeframe | 6-month follow-up for primary outcomes |
This randomized controlled trial assessed the effectiveness of a tablet-based visit planner in helping patients prepare for a primary care visit and closing care gaps. In this study, care gaps referred to testing and treatments that patients need to improve their health, such as blood sugar testing or cancer screening, but have not yet received. The visit planner, which was available in English or Spanish, guided patients through the process of identifying their top priorities for their visits and making sure that they understood the care plan after their visits.
The research team randomly assigned physicians to one of two groups. The team assigned all eligible patients in each physician’s patient panel to the same group. In the first group, patients completed the visit planner in the waiting room and brought a summary of their responses to their visits. In the second group, patients received a healthy lifestyle information sheet. Patients in both groups received usual care throughout the study.
The study included 750 patients who either had multiple chronic conditions or who were new to their primary care physician. All patients received care at a healthcare system in California. Of these patients, 38% were white, 28% were African American, 22% were Hispanic, and 7% were Asian. The average age was 61, and 65% were female.
The research team used medical records to assess patients’ care gaps before visits and monthly for six months. Patients completed surveys on care quality by phone within two weeks of completing their visits.
Patients, community members, and clinicians helped design the visit planner and provided feedback throughout the study.
Results
After six months, the two groups did not differ in care gap closure. Compared with patients who received the handout, those with the visit planner reported higher quality of communication, more often saying they prepared questions for their doctors and told their doctors about their top concerns at the beginning of the visit (both p<0.01).
The groups did not differ in patient satisfaction with care, treatment autonomy, perceived patient-centeredness of visit, treatment adherence, or follow-up visit attendance.
Limitations
The care gaps identified in the medical records may not have aligned with patients’ top priorities for their visits. At the healthcare system in the study, patients with chronic conditions received additional care from nurses and others, which may have affected the study results.
Conclusions and Relevance
The visit planner helped patients identify and express their top visit priorities at the beginning of their visits but did not close care gaps or improve other aspects of patient-reported care quality.
Future Research Needs
Future research could explore ways to address patients’ top priorities during visits and assess whether addressing these priorities leads to improved interactions, care quality, or health.
Final Research Report
View this project's final research report.
Journal Citations
Results of This Project
Related Journal Citations
Peer-Review Summary
Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.
The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.
Peer reviewers commented, and the researchers made changes or provided responses. The comments and responses included the following:
- The reviewers saw a disconnect between the intervention, which sought to encourage patients to discuss issues of concern with their providers, and the primary outcome, which assessed the closing of care gaps that are a priority in the healthcare system. The reviewers asked the researchers to elaborate on the rationale for choosing their primary outcome measure. The researchers agreed that there is a large step from patient priorities to reducing care gaps and that using intermediate measures would have been helpful. The researchers explained that they thought that more effective primary care visits would eventually lead to closing care gaps. They chose an outcome measure that would apply to a heterogeneous group of patients while being salient to the healthcare system. The researchers revised the report to address these issues in the sections on future directions and study limitations.
- Reviewers asked if researchers recorded and categorized patient concerns,and how often these concerns aligned with care gaps. The researchers said that indeed they recorded and categorized patient concernsbut the concerns did not align with specific care gap outcomes. The researchers listed the suggested priorities and subpriorities in two tables in a new appendix. The researchers developed the list of priorities through engagement with the study’s patient advisors.