The impact of county-level factors on meaningful use of electronic health records (EHRs) among primary care providers.
The impact of county-level factors on meaningful use of electronic health records (EHRs) among primary care providers.
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DOI：
10.1371/journal.pone.0295435
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发表时间：
2024
期刊：
影响因子：
3.7
通讯作者：
中科院分区：
文献类型：
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作者：
本研究通过采用、改进或升级（AIU）认证的EHR技术，考察了8415名初级保健提供者（pcp）在佛罗里达州医疗补助EHR激励计划中注册的电子健康记录（EHR）的“有意义使用”（MU）的县级因素的影响。pcp在注册时获得奖励，如果他们以有意义的方式使用他们的电子病历；对病人和提供者都有利的方式他们获得了额外的报酬。我们在2011-2018年期间对这些提供者进行了回顾性队列研究，同时将他们的记录与其他州的数据联系起来。我们使用资源依赖理论（RDT）的核心结构，这是一个成熟的企业管理组织理论，来操作县级变量。这些变量包括农村、贫困、受教育程度、管理医疗普及率、人口变化和人均pcp数量。分析的单位是供应商年。为了实用和计算的目的，所有县变量都被二分类。我们使用方差分析（ANOVA）来检验每个县变量之间MU认证率的差异。比值比和相应的95%置信区间由使用二项式族和logit链接函数的广义估计方程（GEE）的合并逻辑回归得出。采用聚类标准误差。大约42%的供应商在获得第一年的奖励后证明了MU。农村和贫困与MU显著相关。在某种程度上，管理医疗普及率、人口规模变化和人均pcp数量也与MU相关。政策制定者和卫生保健管理者不应忽视县级因素在医生实践中传播电子病历的贡献。这些县级调查结果为传统上服务不足人口居住的地方的电子卫生条例传播提供了重要见解。这种国家视角尤其重要，因为医疗信息技术有可能实现公共健康监测和人口健康管理，这可能使医疗补助提供者治疗的患者以外的个人受益。
This study examines the impact of county-level factors on “meaningful use” (MU) of electronic health records (EHRs) for 8415 primary care providers (PCPs) that enrolled in the Florida Medicaid EHR Incentive Program through adopting, improving, or upgrading (AIU) a certified EHR technology. PCPs received incentive payments at enrollment and if they used their EHRs in meaningful ways; ways that benefit patients and providers alike they received additional payments. We conducted a retrospective cohort study of these providers over the 2011–2018 period while linking their records to other state data. We used the core constructs of the resource dependence theory (RDT), a well-established organization theory in business management, to operationalize the county-level variables. These variables were rurality, poverty, educational attainment, managed care penetration, changes in population, and number of PCPs per capita. The unit of analysis was provider-years. For practical and computational purposes, all the county variables were dichotomized. We used analysis of variance (ANOVA) to test for differences in MU attestation rates across each county variable. Odds ratios and corresponding 95% confidence intervals were derived from pooled logistic regressions using generalized estimated equations (GEE) with the binomial family and logit link functions. Clustered standard errors were used. Approximately 42% of these providers attested to MU after receiving first-year incentives. Rurality and poverty were significantly associated with MU. To some degree, managed care penetration, change in population size, and number of PCPs per capita were also associated with MU. Policy makers and healthcare managers should not ignore the contribution of county-level factors in the diffusion of EHRs among physician practices. These county-level findings provide important insights about EHR diffusion in places where traditionally underserved populations live. This county-perspective is particularly important because of the potential for health IT to enable public health monitoring and population health management that might benefit individuals beyond the patients treated by the Medicaid providers.
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DOI：
10.5455/aim.2013.21.129-134
发表时间：
2013
期刊：
Acta informatica medica : AIM : journal of the Society for Medical Informatics of Bosnia & Herzegovina : casopis Drustva za medicinsku informatiku BiH
影响因子：
--
作者：
Ajami S;Bagheri-Tadi T
通讯作者：
Bagheri-Tadi T
影响因子：
10.4
作者：
DUNCAN, RB
通讯作者：
DUNCAN, RB
影响因子：
2.5
作者：
Abdolrasulnia, Maziar;Menachemi, Mir;Brooks, Robert G.
通讯作者：
Brooks, Robert G.
影响因子：
10.5
作者：
ALDRICH, HE;PFEFFER, J
通讯作者：
PFEFFER, J
影响因子：
9.7
作者：
Diamond, Carol C.;Mostashari, Farzad;Shirky, Clay
通讯作者：
Shirky, Clay