Mining Electronic Health Records to Promote the Reach of Digital Interventions for Cancer Prevention Through Proactive Electronic Outreach: Protocol for the Mixed Methods OptiMine Study.

Michael S Amato,Alex T Ramsey,Zarnie Khadjesari,Sherine El-Toukhy,Tracey Brown,Lorien C Abroms,Henry Goodfellow,Helena Jopling

doi:10.2196/23669

Abstract

BackgroundDigital behavior change interventions have demonstrated effectiveness for smoking cessation and reducing alcohol intake, which ultimately reduce cancer risk. Leveraging electronic health records (EHR) to identify at-risk patients and increasing the reach of digital interventions through proactive electronic outreach provide a novel approach that may increase the number of individuals who engage with evidence-based treatment.ObjectiveThis study aims to increase the reach of digital behavior change interventions by implementing a proactive electronic message system for smoking cessation and alcohol reduction among a large, at-risk population identified through an acute hospital EHR.MethodsThis protocol describes a 3-phase, mixed-methods implementation study to assess the acceptability, feasibility, and reach of a proactive electronic message system to digital interventions using a hospital’s EHR system to identify eligible patients. In Phase 1, we will conduct focus group discussions with patients and hospital staff to assess the overall acceptability of the electronic message system. In Phase 2, we will conduct a descriptive analysis of the patient population in the hospital EHR regarding target risk behaviors and other person-level characteristics to determine the project’s feasibility and potential reach. In Phase 3, we will send proactive messages to patients identified as smokers or risky drinkers. Messages will encourage and provide access to behavior change mobile apps via an embedded link; the primary outcome will be the proportion of participants who click on the link to access information about the apps.ResultsAt the time of initial protocol submission, data collection was complete, but analysis had not begun. This study was funded by Cancer Research UK from April 2019 to March 2020. Health Research Authority approval was granted in June 2019.ConclusionsIncreasing the reach of digital behavior change interventions can improve population health by reducing the burden of preventable death and disease.International Registered Report Identifier (IRRID)DERR1-10.2196/23669

Highlights

Cigarette smoking and risky alcohol consumption, both modifiable behaviors, are among the leading causes of cancer and other diseases [1,2]
Fu et al [42] found that offering tobacco cessation treatment to smoking veterans identified through an electronic health records (EHR) increased quit rates compared to participants who received only usual care. These results suggest that proactive outreach of behavioral interventions to patients who have been identified through EHRs is an acceptable and effective strategy for increasing the reach of health services
The West Suffolk National Health Service (NHS) Foundation Trust (WSFT) EHR system—Cerner Millenium, locally named “eCare”—includes records for all outpatients and inpatients registered with the hospital

Summary

Introduction

Cigarette smoking and risky alcohol consumption, both modifiable behaviors, are among the leading causes of cancer and other diseases [1,2]. Increasing the reach of evidence-based interventions that effectively help people quit smoking and drink less can improve population health by reducing the burden of preventable death and disease. By 2035, reducing tobacco use to under 5% across all socioeconomic groups in the United Kingdom would prevent 35,901 new cases of tobacco-related cancers, 28,997 cases of chronic obstructive pulmonary disease, 24,854 cases of stroke, and 7594 cases of coronary heart disease [4]. Digital behavior change interventions have demonstrated effectiveness for smoking cessation and reducing alcohol intake, which reduce cancer risk. Leveraging electronic health records (EHR) to identify at-risk patients and increasing the reach of digital interventions through proactive electronic outreach provide a novel approach that may increase the number of individuals who engage with evidence-based treatment

Methods

Results

Conclusion