• Jeana M Holt, Rachel Cusatis, Aaron Winn, Onur Asan, Charles Spanbauer, Joni S Williams, Kathryn E Flynn, Melek Somai, AkkeNeel Talsma, Purushottam Laud, Gregory Makoul, and Bradley H Crotty.
• University of Wisconsin-Milwaukee, College of Nursing, Milwaukee, WI, USA. jmholt@uwm.edu.
• J Gen Intern Med. 2021 Nov 1; 36 (11): 3321-3329.

BackgroundPatient contextual data (PCD) are often missing from electronic health records, limiting the opportunity to incorporate preferences and life circumstances into care. Engaging patients through tools that collect and summarize such data may improve communication and patient activation. However, differential tool adoption by race might widen health care disparities.ObjectiveDetermine if a digital tool designed to collect and present PCD improves communication and patient activation; secondarily, evaluate if use impacts outcomes by race.Design, Setting, And ParticipantsA pragmatic, two-armed, non-blinded, randomized controlled trial conducted during 2019 in a primary care setting.InterventionThe PCD tool (PatientWisdom) invited patients to identify preferences, values, goals, and barriers to care. Patients were randomized to a standard pre-visit email or facilitated enrollment with dedicated outreach to encourage use of the tool.Main Outcomes And MeasuresOutcomes of interest were post-visit patient communication and patient activation measured by the Communication Assessment Tool (CAT) and Patient Activation Measure (PAM), respectively. Outcomes were evaluated using treatment-on-the-treated (TOT) and intention-to-treat (ITT) principles.Key ResultsA total of 301 patients were enrolled. Facilitated enrollment resulted in a five-fold increase in uptake of the PCD tool. TOT analysis indicated that the PCD tool was associated with notable increases in specific CAT items rated as excellent: "treated me with respect" (+ 13 percentage points; p = 0.04), "showed interest in my ideas" (+ 14 percentage points; p = 0.03), "showed care and concern" (+ 16 percentage points; p = 0.02), and "spent about the right amount of time with me" (+ 11 percentage points; p = 0.05). There were no significant pre/post-visit differences in PAM scores between arms (- 4.41 percentage points; p = 0.58). ITT results were similar. We saw no evidence of the treatment effect varying by race in ITT or TOT analyses.Conclusions And RelevanceThe inclusion of PCD enhanced essential aspects of patient-provider communication but did not affect patient activation. Outcomes did not differ by race.Trial RegistrationClincaltrials.gov identifier: NCT03766841.© 2021. Society of General Internal Medicine.

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