Maximizing the Impact of ePHIM in Low-Income, Multiethnic Populations

最大限度地发挥 ePHIM 对低收入、多种族人群的影响

• 批准号: 8691495
• 负责人: Thomas A. Arcury
• 金额: $ 47.41万
• 依托单位: WAKE FOREST UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-01 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8691495
• 关键词: Maximizing; Impact; ePHIM; Low; Income

DESCRIPTION (provided by applicant): The ability to access, manage, and understand personal health information enables individuals to become better consumers and participate more fully in making health care decisions. The development of electronic health records and the availability of patient portals for accessing personal health records, coupled with myriad health information via the internet (eHealth), have provided the potential for electronic personal health information management (ePHIM). However, great variability exists in access to eHealth information for components of the US population. Despite continuing efforts, this "digital divide" remains for rural, minority and low-income communities. Limited access for ePHIM contributes to the health disparities experienced by these populations. The goal of this project is to improve the ability of low-income African American, American Indian, Latino, and white older adults living in rural and urban communities to use information technology applications for ePHIM. The project's conceptual framework combines the Technology Acceptance Model and the person- environmental interaction model. It uses a community-based participatory partnership of Wake Forest School of Medicine and its Outpatient Department Medicine Clinic, with Community Partners HealthNet, a network of 18 clinics serving 25 rural North Carolina counties, to achieve 3 specific aims: (1) document the ePHIM experience, knowledge, perceived needs, and perceived risks of low-income African American, American Indian, Latino, and white older adults living in rural and urban communities~ (2) delineate the actual use of ePHIM by low-income African American, American Indian, Latino, and white older adults living in rural and urban communities~ and (3) delineate differences in perception, belief and experience in using ePHIM between patients and caregivers who use versus those who do not use ePHIM. This project is significant because it will delineate disparities in ePHIM by working with two networks of clinics (Community Partners HealthNet~ Outpatient Department Medicine Clinic/Wake Forest Baptist Health) that provides care to rural and urban, low- income, and minority patients. Working with these networks, this project will implement in-depth and longitudinal research that will delineate the factors affecting ePHIM use among vulnerable elders. This project is innovative. (1) It will use qualitative data collection techniques within a community-based participatory research framework to assess the motives and barriers to patients' and caregivers' ePHIM among rural as well as urban, low-income, older adult, and minority communities. (2) It emphasizes the importance of including caregivers, particularly for older adults, in understanding the use of ePHIM. (3) It will use these qualitative methods to assess the perceptions of health care providers and IT providers about the potential use of ePHIM. (4) It will use these qualitative methods to determine the factors that facilitated and limited the use of ePHIM by comparing high / expert, medium, and low users. (5) It will document the actual pattern of ePHIM use among older adults and their caregivers over a one-year period. (6) It will explore the association of ePHIM use and chronic disease management among older adults.

描述（由申请人提供）：访问、管理和理解个人健康信息的能力使个人能够成为更好的消费者并更充分地参与医疗保健决策。 电子健康记录的发展和用于访问个人健康记录的患者门户的可用性，再加上通过互联网（eHealth）提供的大量健康信息，为电子个人健康信息管理（ePHIM）提供了潜力。 然而，美国不同人群在获取电子医疗信息方面存在很大差异。尽管不断努力，农村、少数民族和低收入社区仍然存在这种“数字鸿沟”。 ePHIM 的访问受限加剧了这些人群所经历的健康差异。 该项目的目标是改善 生活在农村和城市社区的低收入非裔美国人、美洲印第安人、拉丁裔和白人老年人使用 ePHIM 信息技术应用程序的能力。 该项目的概念框架结合了技术接受模型和人-环境交互模型。 它利用维克森林医学院及其门诊部医学诊所与社区合作伙伴 HealthNet（一个由 18 家诊所组成的网络，为北卡罗来纳州 25 个农村县提供服务）建立的基于社区的参与性伙伴关系，以实现 3 个具体目标：(1) 记录 ePHIM生活在农村和城市社区的低收入非裔美国人、美洲印第安人、拉丁裔和白人老年人的经验、知识、感知需求和感知风险 ~ (2) 描述低收入非洲人对 ePHIM 的实际使用情况生活在农村和城市社区的美国人、美洲印第安人、拉丁裔和白人老年人 ~ 以及 (3) 描绘了使用 ePHIM 的患者和护理人员与不使用 ePHIM 的患者和护理人员在使用 ePHIM 的认知、信念和经验方面的差异。 该项目意义重大，因为它将通过与两个为农村和城市、低收入和少数族裔患者提供护理的诊所网络（社区合作伙伴 HealthNet~门诊部医学诊所/维克森林浸信会健康中心）合作，描绘 ePHIM 中的差异。 该项目将与这些网络合作，开展深入的纵向研究，描述影响弱势老年人使用 ePHIM 的因素。 该项目具有创新性。 (1) 它将在基于社区的参与性研究框架内使用定性数据收集技术来评估农村和城市、低收入、老年人和少数族裔社区中患者和护理人员进行 ePHIM 的动机和障碍。 (2) 它强调让护理人员（尤其是老年人）参与了解 ePHIM 的使用的重要性。 (3) 它将使用这些定性方法来评估医疗保健提供者和 IT 提供者对 ePHIM 潜在用途的看法。 (4) 它将使用这些定性方法来确定促进和限制使用的因素 ePHIM 通过比较高/专家、中和低用户。 (5) 它将记录老年人及其护理人员一年内 ePHIM 使用的实际模式。 (6) 它将探讨老年人中 ePHIM 使用与慢性病管理的关联。