Use of electronic health records in underserved communities in Florida

在佛罗里达州服务欠缺的社区使用电子健康记录

基本信息

批准号：
10580502
负责人：
PIERRE K ALEXANDRE
金额：
$ 43.73万
依托单位：
FLORIDA ATLANTIC UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-04-05 至 2025-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10580502
关键词：
Academic Research Enhancement Awards Address Adopted Adoption American Area Certification Clinical Clinical Data Communication Communities Continuity of Patient Care Cost Control County Data Data Set Data Sources Databases Dependence Digit structure Disparity Disparity population Economics Electronic Health Record Electronics Eligibility Determination Environment Estimation Techniques Ethnic Origin Exposure to Faculty Florida Funding Goals Health Health Benefit Health Resources Healthcare Heterogeneity Incentives Insurance Intervention Investments Journals Linear Models Link Literature Logistics Low income Measures Medicaid Medical Methods Modeling Outcome Outpatients Participant Patients Peer Review Policies Policy Maker Population Printing Process Provider Public Health Race Racial Equity Recording of previous events Records Recovery Regulation Reporting Research Resources Retrospective cohort study Safety Strategic Planning System Technology Training Underserved Population United States United States Centers for Medicare and Medicaid Services United States National Institutes of Health Vulnerable Populations beneficiary comorbidity design digital electronic health information empowerment ethnic minority experience geographic disparity graduate student health administration health assessment health disparity health equity health information technology improved incentive program inner city innovation insight interoperability medical specialties member payment population health power analysis programs public health relevance racial minority repository rural area socioeconomic disparity socioeconomics theories undergraduate student underserved community uptake

项目摘要

The Center for Medicare and Medicaid Services (CMS) has acknowledged its commitment to promoting widespread Meaningful Use (MU) of Electronic Health Records (EHRs) through over $30 billion investment of funds from the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, through the CMS Promoting Interoperability (MPI) program. Underlying this effort is the potential gain of improved health outcomes through the timely transfer of electronic health information across the care continuum. The Florida Medicaid Promoting Interoperability (FMPI) program started in 2011 through 2021, but less than half of Medicaid providers attested to MU (i.e., advanced EHR functions) of EHRs as of 2018, potentially creating an advanced use “digital divide” in the State. Medicaid/CHIP serves over 83.6 million beneficiaries in the United States, many of whom are traditionally low-income, vulnerable individuals with multiple comorbidities. It is thus critical to assess whether Federal funding designed to promote MU adoption is effective rather than inadvertently exacerbate health information technology disparities. The overall objective of this proposal is to data from the FMPI to estimate local-area MU rates of EHRs and assess whether MU of EHRs is lagging in areas with a high concentration of traditionally underserved populations. More specifically, the aims of this proposal are: Aim 1: Estimate MU rates of EHRs in areas with high concentration of low-income residents; assess whether MU rates are lagging in these areas; and examine the factors associated with MU rates in these areas. Aim 2: Estimate MU rates of EHRs in areas with high concentration of racial and ethnic minority residents; assess whether MU rates are lagging in these areas; and examine the factors associated with MU rates in these areas. Aim 3: Estimate MU rates of EHRs in rural areas and inner cities; assess whether MU rates are lagging in these areas; and examine the factors associated with MU rates in these areas. We will conduct a retrospective cohort study using records of 8748 medical practices from the FMPI’s Provider Participation Database. Using the participant’s 10-digit national provider identification (NPI) and county identifier, this database will be linked to other datasets from state and federal data sources. Innovative theoretical framework (Resource Dependence Theory) and estimation techniques (power analysis, logistic and probit random effects models, clustered standard errors, unobserved heterogeneity “debiasing method”, Heckman selection, and Hierarchical Generalized Linear Model (HGLM)) will be used. As an Academic Research Enhancement Award (AREA), we will involve graduate and undergraduate students in all aspects of the study as integral members of the research team, providing intensive exposure to and training in research. We will disseminate our research through digital, print, and presentation forums, and FAU open-access digital resource repositories, local community venues, and peer-reviewed journals.

医疗保险和医疗补助服务中心（CMS）已承认其对促进的承诺通过超过300亿美元投资的电子健康记录（EHRS）的有意义使用（MU）《 2009年《经济与临床健康健康技术技术》（HITECH）法案的资金，通过促进互操作性（MPI）程序的CMS。这项工作的基础是潜在的收益通过及时转移电子健康信息在整个护理中，改善了健康结果连续。佛罗里达州医疗补助促进互操作性（FMPI）计划于2011年至2021年开始但是，截至2018年，不到一半的医疗补助提供商证明了EHR的MU（即高级EHR功能），可能在该州创建高级使用“数字鸿沟”。医疗补助/芯片可服务8360万美国的受益人，其中许多传统上是低收入，脆弱的人多种合并症。因此，评估旨在促进MU采用的联邦资金是否至关重要是有效的，而不是无意间加剧健康信息技术分布。该提案的总体目的是从FMPI的数据估算EHR的本地地区MU率和评估EHR的MU是否落后于传统水平较高的地区人群。更具体地说，该提案的目的是： AIM 1：估计低收入居民浓度高的地区EHR的MU速率；评估是否Mu 这些领域的费率落后；并检查这些领域中与MU速率相关的因素。目标2：估计种族和少数民族居民浓度高的地区EHR的MU率；评估MU率是否在这些领域落后；并检查这些领域中与MU速率相关的因素。 AIM 3：估计在崎ground的地区和内城市中EHR的MU速率；评估MU率是否落后于此区域；并检查这些领域中与MU速率相关的因素。我们将使用FMPI的8748个医疗实践记录进行回顾性队列研究提供者参与数据库。使用参与者的10位国家提供商识别（NPI）和县标识符，该数据库将链接到州和联邦数据源的其他数据集。创新的理论框架（资源依赖理论）和估计技术（功率分析，逻辑和概率随机效应模型，群集的标准误差，未观察到的异质性“偏见方法”，将使用Heckman选择和分层通用线性模型（HGLM）。作为学术研究增强奖（区域），我们将参与研究生和本科研究团队不可或缺的研究成员，在研究的各个方面的学生，提供密集的接触和研究培训。我们将通过数字，印刷和演示论坛传播我们的研究，以及FAU开放式数字资源存储库，本地社区场所和同行评审的期刊。