Patient-Centered Personal Health Record and Portal Implementation Toolkit for Ambulatory Clinics: A Feasibility Study.

Personal health records and patient portals have been shown to be effective in managing chronic illnesses. Despite recent nationwide implementation efforts, the personal health record and patient portal adoption rates among patients are low, and the lack of support for patients using the programs remains a critical gap in most implementation processes. In this study, we implemented the Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit in a large diabetes/endocrinology center and assessed its preliminary impact on personal health record and patient portal knowledge, self-efficacy, patient-provider communication, and adherence to treatment plans. Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit is composed of Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit-General, clinic-level resources for clinicians, staff, and patients, and Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit Plus, an optional 4-week online resource program for patients ("MyHealthPortal"). First, Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit-General was implemented, and all clinicians and staff were educated about the center's personal health record and patient portal. Then general patient education was initiated, while a randomized controlled trial was conducted to test the preliminary effects of "MyHealthPortal" using a small sample (n = 74) with three observations (baseline and 4 and 12 weeks). The intervention group showed significantly greater improvement than the control group in patient-provider communication at 4 weeks (t56 = 3.00, P = .004). For other variables, the intervention group tended to show greater improvement; however, the differences were not significant. In this preliminary study, Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit showed potential for filling the gap in the current personal health record and patient portal implementation process. Further studies are needed using larger samples in other settings to ascertain if these results are generalizable to other populations.

Removal and fate of polycyclic aromatic hydrocarbon pollutants in an urban stormwater bioretention facility.

This research investigated the removal and fate of 16 USEPA priority pollutant polycyclic aromatic hydrocarbons (PAHs) from urban stormwater runoff through a bioretention cell. Bioretention is an infiltration/filtration practice containing a mixed layer of about 90 cm of soil, sand, and organic matter, planted with appropriate vegetation. Field water quality monitoring and bioretention media core analyses were performed. The results indicate that bioretention is a promising management practice to control runoff PAH pollutants. The PAH event mean concentration (EMC) reduction ranged from 31 to 99%, with a mean discharge EMC of 0.22 microg/L. The mass load decreased from a mean value of 0.0180 kg/ha yr to 0.0025 kg/ha yr, suggesting an average PAH mass load reduction of 87% to the discharging watershed. The most dominant PAH species monitored were fluoranthene and pyrene. Influent PAHs indicated strong affiliation with runoff total suspended solids (TSS). As such, PAH removal positively correlated with TSS removal. Low rainfall depth was associated with high influent PAH concentration and resulted in favorable PAH removal. Source investigation suggested that the PAHs measured in the monitored cell were from pyrogenic sources, likely resulting from vehicle combustion processes. Sealers used in parking lots and driveway coatings were also a possible source of PAHs. Media core analyses indicated that the intercepted PAH compounds transported only a few centimeters vertically in the soil media near the runoff entrance location, suggesting that a shallow cell design may be adequate for systems focusing on PAH removal.