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Ann Fam Med. 2019 Mar;17(2):141-149. doi: 10.1370/afm.2352.

Visit Planning Using a Waiting Room Health IT Tool: The Aligning Patients and Providers Randomized Controlled Trial.

Author information

1
Division of Research, Kaiser Permanente Northern California, Oakland, California Richard.W.Grant@kp.org.
2
Division of Research, Kaiser Permanente Northern California, Oakland, California.
3
Center for Vulnerable Populations and Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, California.
4
Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado.
5
Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado.
6
Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.
7
University of Michigan Department of Internal Medicine, Ann Arbor, Michigan.

Abstract

PURPOSE:

Time during primary care visits is limited. We tested the hypothesis that a waiting room health information technology (IT) tool to help patients identify and voice their top visit priorities would lead to better visit interactions and improved quality of care.

METHODS:

We designed a waiting room tool, the Visit Planner, to guide adult patients through the process of identifying their top priorities for their visit and effectively expressing these priorities to their clinician. We tested this tool in a cluster-randomized controlled trial with usual care as the control. Eligible patients had at least 1 clinical care gap (eg, overdue for cancer screening, suboptimal chronic disease risk factor control, or medication nonadherence).

RESULTS:

The study (conducted March 31, 2016 through December 31, 2017) included 750 English- or Spanish-speaking patients. Compared with usual care patients, intervention patients more often reported "definitely" preparing questions for their doctor (59.5% vs 45.1%, P <.001) and "definitely" expressing their top concerns at the beginning of the visit (91.3% vs 83.3%, P = .005). Patients in both arms reported high levels of satisfaction with their care (86.8% vs 89.9%, P = .20). With 6 months of follow-up, prevalence of clinical care gaps was reduced by a similar amount in each study arm.

CONCLUSIONS:

A simple waiting room-based tool significantly improved visit communication. Patients using the Visit Planner were more prepared and more likely to begin the visit by communicating their top priorities. These changes did not, however, lead to further reduction in aggregate clinical care gaps beyond the improvements seen in the usual care arm.

KEYWORDS:

competing demands; complex patients; doctor-patient communication; health IT; office visits; practice gaps; practice-based research; primary care; priorities

PMID:
30858257
PMCID:
PMC6411400
[Available on 2019-09-01]
DOI:
10.1370/afm.2352
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