Changes in Disparities Following the Implementation of a Health Information Technology-Supported Quality Improvement Initiative
Changes in Disparities Following the Implementation of a Health Information Technology-Supported Quality Improvement Initiative
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DOI：
10.1007/s11606-011-1842-2
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发表时间：
2012-01-01
影响因子：
5.7
通讯作者：
Baker, David W.
中科院分区：
文献类型：
--
作者：
Jean-Jacques, Muriel;Persell, Stephen D.;Baker, David W.
健康信息技术（HIT）支持的质量改进举措已被证明可以提高几种慢性病和预防服务的门诊护理质量，但尚不清楚这些类型的举措是否会减少差异。HIT-时间序列模型被用来评估不同种族之间的表现差异的变化，2008年2月至2010年2月，实施HIT支持的前2年，白色和黑人患者接受17项慢性病和预防护理措施，提供者指导的质量改进计划。黑人和白色成人在芝加哥的一个学术普通内科实践中接受护理。质量改进计划使用提供者指导的点-护理临床决策支持工具和质量反馈，以改善冠心病、心力衰竭、高血压和糖尿病的护理过程和中间结局指标，以及接受几种预防服务。模拟性能变化率，17项门诊护理质量指标按种族和模型变化率分层白色患者17项指标中有14项和黑人患者17项指标中有10项的护理质量得到改善。白色和黑人患者的质量提高了五个过程的护理措施，四个五预防服务，但没有四个中间结果的措施。在基线时存在种族差异的七项措施中，实施质量改进倡议后，两项措施的差异下降，四项措施保持稳定，一项措施增加。普遍的和以提供者为导向的质量改进倡议可以减少某些慢性病和预防保健措施的种族差异，但在持续存在差异的领域实现公平需要更有针对性，以患者为导向，和系统导向的战略。
Health information technology (HIT)-supported quality improvement initiatives have been shown to increase ambulatory care quality for several chronic conditions and preventive services, but it is not known whether these types of initiatives reduce disparities.To examine the effects of a multifaceted, HIT-supported quality improvement initiative on disparities in ambulatory care.Time series models were used to assess changes in racial disparities in performance between white and black patients for 17 measures of chronic disease and preventive care from February 2008 through February 2010, the first 2 years after implementation of a HIT-supported, provider-directed quality improvement initiative.Black and white adults receiving care in an academic general internal medicine practice in Chicago.The quality improvement initiative used provider-directed point-of-care clinical decision support tools and quality feedback to target improvement in process of care and intermediate outcome measures for coronary heart disease, heart failure, hypertension, and diabetes as well as receipt of several preventive services.Modeled rate of change in performance, stratified by race and modeled rate of change in disparities for 17 ambulatory care quality measuresQuality of care improved for 14 of 17 measures among white patients and 10 of 17 measures among black patients. Quality improved for both white and black patients for five of eight process of care measures, four of five preventive services, but none of the four intermediate outcome measures. Of the seven measures with racial disparities at baseline, disparities declined for two, remained stable for four, and increased for one measure after implementation of the quality improvement initiative.Generalized and provider-directed quality improvement initiatives can decrease racial disparities for some chronic disease and preventive care measures, but achieving equity in areas with persistent disparities will require more targeted, patient-directed, and systems-oriented strategies.