Quality improvement (QI) models and evidence-based self-management guidelines for reducing cardiovascular disease (CVD) risk require patients to access community resources. The purpose of this study is to describe outcomes from implementation of a community resource referral system into small clinical practices to reduce CVD risk. Practices were given the opportunity to complete an inventory of local CVD-related resources; these data were used to create a printed list of resources for patients (“HealtheRx-H3”). Practices could request updates to HealtheRx-H3s. We assessed implementation outcomes, including appropriateness, feasibility, and adoption. Practice populations were at high risk for CVD. It was feasible to create practice-specific HealtheRx-H3s. Systematic distribution of HealtheRx-H3s using digital electronic health record (EHR) integration was infeasible due to inconsistent use of EHR systems, workflow variation, and lacking data-sharing infrastructure. Of 76 practices, 38 completed the inventory; completion was similar by patient and practice characteristics. HealtheRx-H3 updates were requested by 39% of practices; practices that completed the inventory were significantly more likely to request an update compared with those that did not (61% vs. 18%, p-value <.01). Successful implementation of QI strategies to systematize community resource referral solutions is feasible at small practices, but more research is needed to understand what motivates small practices to participate in implementation of these solutions.

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Background: Diagnosis and treatment of breast cancer often involves several surgical procedures. Women with breast cancer are asked repeatedly to report their breast surgery history, often elicited in an open-ended format and relying on patient recall. Electronic medical records (EMR) and other medical documentation are not always readily available. No comprehensive, validated patient-reported measure of breast surgery history exists. We developed a close-coded, digital survey tool to elicit patient-reported breast surgery history (PRoBe-SH). Methods: We administered the PRoBe-SH survey tool to a convenience sample of patients with a history of breast cancer. We compared PRoBe-SH data to both surgical history documented in patients’ EMR and open-ended surgical history ascertained from patient-completed clinic intake forms. Sensitivity/specificity analyses and McNemar’s tests were performed. Results: Data from fifty patients (median age 53.5 years, range 31-71, 70% non-Hispanic white) were analyzed. The sensitivity of the PRoBe-SH for accurately identifying surgical history was 100% for mastectomy, lumpectomy 96%, mastectomy sidedness 100% (right) and 100% (left), lumpectomy sidedness 36% (right) 55% (left), lymphadenectomy 64%, breast reconstruction 89%, and presence of a native nipple 100% (right) and 100% (left). Open-ended surgical history was more than 90% sensitive for identifying mastectomy and lumpectomy only. The PRoBe-SH was significantly more sensitive than open-ended surgical history for identifying mastectomy sidedness (P<0.01), lymphadenectomy (P<0.01), and breast reconstruction (P<0.01). Conclusion: Ascertaining accurate breast surgical history is important in the context of clinical care and for research purposes. The PRoBe-SH is a comprehensive, highly sensitive alternative to obtaining an open-ended breast surgical history when EMR data or other medical documentation are not available.

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