A Study of an EHR to Translate Public Health Practices

电子病历转化公共卫生实践的研究

• 批准号: 7684193
• 负责人: Rita Kukafka
• 金额: $ 44.8万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-29 至 2011-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7684193
• 关键词: Study; EHR; Translate; Public; Health

DESCRIPTION (provided by applicant): Ample evidence demonstrates that public health elements such as preventive care reminders, quality measurement, immunization registries, and patient education materials provide public health value, yet dissemination is poor. Electronic health records (EHRs) may provide a solution, but poor EHR adoption and poor incorporation of public health elements into EHRs limit their broad use. The New York City government is carrying out a unique project to improve the health of the city, investing over $27 million to implement a public health enabled EHR (PHEEHR) to providers who treat underserved patients throughout the city. Our project is to study this PHEEHR New York City implementation with the goal of discovering strategies that can enhance PHEEHR adoption and impact. Specific aims are 1) to study the implementation process by examining across practice settings the contextual factors that contribute to the adoption and impact of the PHEEHR; 2) to study how the complex relationships between public health elements and environmental task elements facilitate or hamper adoption and impact of the PHEEHR and 3) to develop and disseminate generalizable conclusions based on the results of aims 1 and 2. We will use the DeLone and McLean Information System Model to evaluate the causal paths that begin with the PHEEHR system itself, and incorporate user satisfaction, adoption, and impact. Impact in this study is multifaceted measured in part by an increase in the proportion of provider sites that perform preventative services and public health reporting based on Healthy People 2010 and the U.S. Preventive Services Task Force guidelines. The DeLone and McLean model and an extended model with a task-technology fit construct will be empirically tested with quantitative qualitative and relational data collected from 327 practice settings. Multilevel structural equation modeling (ML-SEM) will be used to evaluate both models. To maximize the generalizability of our findings, we will adhere to standardized multidimensional reporting metrics from the RE-AIM framework specifically designed to improve the translatability of research findings. Our goal is to extend what we learn from this unprecedented New York City PHHEHR implementation research study to inform others that are likely to engage in similar PHEEHR implementations in the future.

描述（由申请人提供）： 充足的证据表明，预防保健提醒、质量测量、免疫登记和患者教育材料等公共卫生要素具有公共卫生价值，但传播较差。电子健康记录 (EHR) 可能提供一种解决方案，但 EHR 采用率低以及公共卫生要素未能融入 EHR 限制了其广泛使用。纽约市政府正在实施一项独特的项目来改善城市的健康状况，投资超过 2700 万美元，为全市服务不足的患者的医疗服务提供者实施公共卫生支持的 EHR (PHEEHR)。我们的项目是研究 PHEEHR 纽约市的实施情况，目标是发现可以增强 PHEEHR 采用率和影响力的策略。具体目标是 1) 通过跨实践环境检查有助于 PHEEHR 采用和影响的背景因素来研究实施过程； 2) 研究公共卫生要素和环境任务要素之间的复杂关系如何促进或阻碍 PHEEHR 的采用和影响，以及 3) 根据目标 1 和 2 的结果制定和传播可推广的结论。我们将使用 DeLone 和McLean 信息系统模型，用于评估从 PHEEHR 系统本身开始的因果路径，并纳入用户满意度、采用率和影响。这项研究的影响是多方面的，部分是通过根据《健康人群 2010》和美国预防服务工作组指南提供预防服务和公共卫生报告的提供商站点比例的增加来衡量的。 DeLone 和 McLean 模型以及具有任务技术拟合结构的扩展模型将使用从 327 个实践环境中收集的定量定性和关系数据进行实证测试。多级结构方程模型（ML-SEM）将用于评估这两个模型。为了最大限度地提高我们研究结果的普遍性，我们将遵守 RE-AIM 框架中的标准化多维报告指标，该框架专门用于提高研究结果的可翻译性。我们的目标是扩展我们从这项史无前例的纽约市 PHHEHR 实施研究中学到的知识，为未来可能参与类似 PHEEHR 实施的其他人提供信息。