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Implementing Health Information Technology in a Patient-Centered Manner: Patient Experiences With an Online Evidence-Based Lifestyle Intervention

Lyden, Jennifer R.; Zickmund, Susan L.; Bhargava, Tina D.; Bryce, Cindy L.; Conroy, Molly B.; Fischer, Gary S.; Hess, Rachel; Simkin-Silverman, Laurey R.; McTigue, Kathleen M.

The Journal for Healthcare Quality (JHQ): September-October 2013 - Volume 35 - Issue 5 - p 47–57
doi: 10.1111/jhq.12026
Feature Articles

Abstract: The patient-centered care (PCC) model and the use of health information technology (HIT) are major initiatives for improving U.S. healthcare quality and delivery. A lack of published data on patient perceptions of Internet-based care makes patient-centered implementation of HIT challenging. To help ascertain patients’ perceptions of an online intervention, patients completing a 1-year web-based lifestyle intervention were asked to complete a semistructured interview. We used qualitative methodology to determine frequency and types of interview responses. Overall satisfaction with program features was coded on a Likert-type scale. High levels of satisfaction were seen with the online lifestyle coaching (80%), self-monitoring tools (57%), and structured lesson features (54%). Moderated chat sessions and online resources were rarely used. Frequently identified helpful aspects were those that allowed for customized care and shared decision-making consistent with the tenets of PCC. Unhelpful program aspects were reported less often. Findings suggest that despite challenges for communicating effectively in an online forum, the personalized support, high-tech data management capabilities, and easily followed evidence-based curricula afforded by HIT may be a means of providing PCC and improving healthcare delivery and quality.

For more information on this article, contact Jennifer R. Lyden at

Jennifer R. Lyden, MD, is a clinical instructor of Internal Medicine at Harborview Medical Center, Seattle, Washington, DC. Her research interests include access to care and healthcare delivery in underserved populations.

Susan L. Zickmund, PhD, is an expert in mixed qualitative–quantitative methods focusing on barriers to adherence as well as other complex topics, such as Military Sexual Trauma, and patient satisfaction. She is an associate professor in Medicine and the Clinical and Translational Science at the University of Pittsburgh and is the cochair of the Veterans Administration (VA) Center for Health Equity Research and Promotion's (CHERP) Qualitative Core located in Pittsburgh, PA. She has a PhD in Communication Studies from the University of Wisconsin, Madison, which she gained in 1993.

Tina D. Bhargava, DrPH, is an assistant professor of Social and Behavioral Sciences at Kent State University. Her research interests include health behavior change as well as cognitive limitations that may affect success with behavior change, particularly regarding weight loss.

Cindy L. Bryce, PhD, is an associate professor of Health Policy and Management, Medicine, and Clinical and Translational Science and the associate dean for Student Affairs at the University of Pittsburgh Graduate School of Public Health. Her methodological interests include operations research, simulation modeling, and decision sciences (decision analysis, quality of life assessment, and economic evaluation), and her research expertise focuses on organ transplantation policy, surrogate decision making during critical illness, and diabetes prevention and management.

Molly B. Conroy, MD, MPH, is an assistant professor of Medicine and Epidemiology at the University of Pittsburgh. She is an internal medicine physician at the University of Pittsburgh, with research interests focusing on the epidemiology of physical activity and interventions to promote healthy lifestyles among primary care patients.

Gary S. Fischer, MD, is associate professor in the University of Pittsburgh School of Medicine. He currently is vice chair for Quality Improvement and Patient Safety for the Department of Medicine, associate medical director of the outpatient medical record for the University of Pittsburgh Medical Center, and is a practicing internist who is medical director of the University of Pittsburgh physicians' general internal medicine practice.

Rachel Hess, MD, MS, is an associate professor of Medicine, Epidemiology, and Clinical and Translational Sciences at the University of Pittsburgh. She is a health services researcher with interests in health information technology interventions in primary care and health-related quality of life.

Laurey R. Simkin-Silverman, PhD, is an assistant professor of Epidemiology in the Graduate School of Public Health at the University of Pittsburgh, Pittsburgh, PA. She works as a coinvestigator on several projects evaluating online behavioral lifestyle interventions in primary care. She is also a coinvestigator on the CDC Prevention Research Center, Center for Aging and Population Health.

Kathleen M. McTigue, MD, MPH, is an associate professor of Medicine at the University of Pittsburgh. She is the director of the Clinical Scientist Track, and associate director for Research of the International Scholars Track of the Internal Medicine Residency Program of the University of Pittsburgh and the University of Pittsburgh Medical Center. She is a general internal medicine physician whose primary research interests are in the prevention and epidemiology of chronic disease and the use of health information technology to improve the quality of primary care medicine.

Grant sponsor: Department of Defense; Grant Number: USAMRAA W81XWH-04–2–0030.

© 2013 National Association for Healthcare Quality
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