Evaluating the Effectiveness of a Health Information Technology Self-Management Program for Chronic Disease - 2012

Principal Investigator
Funding Mechanism
RFA: HS08-269: Exploratory and Developmental Grant to Improve Health Care Quality Through Health Information Technology (IT) (R21)
Grant Number
R21 HS 021005
Project Period
June 2012 – June 2014
AHRQ Funding Amount

Summary: According to a recent statewide community health needs assessment, care and treatment of chronic conditions represent some of the highest health care costs in Eastern Maine. Health information technology has the potential to improve the lives of patients with chronic conditions as well as to reduce health care costs, especially for those in medically underserved areas. This project aims to improve care coordination between health care providers, patients, and care managers by implementing and evaluating an interactive patient-centered Web-based portal that is embedded in the electronic medical record (EMR) in five primary care practices. The target population is patients who have diabetes mellitus, chronic obstructive pulmonary disease, and/or congestive heart failure within an advanced patient-centered medical home environment.

Specific Aims:

  • Develop the interface between the EMR and the patient portal with the disease-specific plan of care forms and patient-referred information. (Ongoing)
  • Implement and evaluate the effectiveness of the comprehensive patient portal. (Ongoing)

2012 Activities: The project is in the start-up phase. Dr. Sorondo and the research team are developing a smart wellness questionnaire that will be embedded into the patient portal and stored in the EMR for provider use. The goal of the survey is to assess patient outcomes, functional status, self-efficacy, quality of life, wellness, and patient health risk assessment. The research team is mapping the survey questions to the data elements in the EMR to determine if any new fields need to be added to accommodate the survey. As last self-reported in the AHRQ Research Reporting System, project progress and activities are on track, and project spending is somewhat underspent to save funds for more cost-intensive activities.

Preliminary Impact and Findings: There are no findings to date.

Target Population: Adults, Chronic Care*, Chronic Obstructive Pulmonary Disease (COPD), Congestive Heart Failure (CHF), Diabetes

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care.

Business Goal: Implementation and Use

* This target population is one of AHRQ’s priority populations.