Injury PreventionBetter health while you wait: A controlled trial of a computer-based intervention for screening and health promotion in the emergency department*,**
Introduction
Two common problems in the emergency department are long waiting times and a failure to identify sensitive personal and public health risks. These stem from constraints on provider time. Could patient waiting time, commonly perceived as time wasted, be used as an opportunity for screening and health promotion? We hypothesized that we might be able to address these issues with the use of a self-administered computer-based program. A review of the literature indicates that patients find computer-based health risk appraisal acceptable and are more likely to answer sensitive questions truthfully on a computer.1, 2, 3, 4, 5 However, there is limited experience with integrating interactive computer systems into clinical practice.6 We developed such a system, Prevent HealthQuiz, and evaluated its utility for nonurgent patients waiting for care in an urban ED.
The ED may constitute an advantageous venue for reaching out to people with serious health risks. There are approximately 100 million ED patient visits per year in the United States. Many ED patients are without a regular source of care.7, 8, 9 Beyond the need for linkage to primary care and community-based resources, there is evidence that preventive services may be acceptable to ED patients10, 11 and cost-effective, particularly for vulnerable populations.12, 13, 14 Most ED patients have acute health care problems but are not critically ill. In the ED setting, these patients are assigned to nonurgent triage categories and often spend a significant amount of time waiting to be seen by the physician. Is this waiting time a potential “teachable moment”?
We wanted to determine whether ED patients were interested in health risk assessment and health promotion. Further, we were interested in its effect on patient recall of health advice. Finally, we sought to assess the practical utility of using patient waiting time for screening and health education in a manner that would not interfere with patient flow in a busy inner-city ED.
Section snippets
Materials and methods
We conducted a controlled clinical trial of a computer-based health risk assessment in an inner-city university teaching hospital ED with approximately 38,000 adult visits per year, 40% of which are classified as nonurgent. Health care is provided by emergency medicine and internal medicine residents who are supervised by emergency medicine faculty members. Our study focused solely on patients assigned to nonurgent triage categories. We used a quasi-randomized design based on alternating
Results
During a 6-month period, the research assistants approached 570 nonurgent patients. Twenty-eight were ineligible because of pain (n=21) or had no access to a telephone (n=7). Four hundred eighty-three (89%) of eligible patients agreed to participate, and 470 of them were enrolled into 1 of the 2 study arms. The remaining 13 patients were called for treatment before being assigned. Two hundred forty-eight patients were assigned to the prevention group and 222 patients were assigned to the
Discussion
We found it feasible to use computer survey technology for risk factor screening and health promotion in the acute care setting. ED patients were very accepting of this technology and interested in using their waiting time as an opportunity to receive health information. Of importance, patients receiving the computer intervention were more likely than the control group to remember being given health advice 1 week after the ED visit.
The US Preventive Services Task Force and Centers for Disease
Acknowledgements
We acknowledge the contributions of James Walter, MD, Linda Druelinger, MD, Jon Olsen, MD, Robert Mulliken, MD, Jack Iwashyna, Richard Kim, Lance Becker, MD, Terry VandenHoek, MD, Annette Miller, RN, Sue French, RN, David Mingay, PhD, and Dexter Voisin, PhD. In addition, John Bailar, MD, Marshall Chin, MD, and Nicholas Christakis, MD, PhD, provided valuable editorial advice.
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Supported by a grant from The Chicago Community Trust (No. 6-35467), the Robert Wood Johnson Clinical Scholars Program, and the University of Chicago Section of Emergency Medicine, Department of Medicine. Technical and computer program development support was provided by The Clinical Practice Enhancement and Anesthesia Research Foundation at the University of Chicago. The University of Chicago and 2 other universities have jointly licensed their rights in HealthQuiz to a nonprofit foundation. If this process is made financially viable, physicians at the University of Chicago Department of Anesthesia and Critical Care may benefit by support of their research. HealthQuiz is currently available free on the Internet at www.healthquiz.com. The primary investigator on the project, Karin Rhodes, MD, is an emergency physician currently supported by the Robert Wood Johnson Foundation as a first-year fellow in the Clinical Scholars Program at the University of Chicago.
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Address for reprints: Karin Rhodes, MD, University of Chicago, Robert Wood Johnson Clinical Scholars Program, 5841 S Maryland Avenue, MC 2007, B234, Chicago, IL 60637; 773-834-4094, fax 773-702-1295; E-mail [email protected].