Association between clinical decision support systems and health care disparities

描述（由申请人提供）：卫生信息技术（HIT）被推荐为降低卫生保健成本、提高质量和促进患者安全的一种手段。临床决策支持系统（CDSS）是卫生信息技术帮助提高护理质量的一个要素。拟议的论文研究将调查在何种程度上增加使用CDSS可能有助于减少种族和农村/城市卫生质量差距。将通过检查有和没有CDSS的医院内的急性心肌梗死（AMI）和肺炎患者来研究过程和结果质量指标的差异。黑人和西班牙裔患者在这两种情况下接受的推荐护理较低，因此健康状况较差。此外，与城市居民相比，农村居民接受AMI的推荐护理较低。本论文通过检查HIT系统（即CDSS）的潜力来推进先前的研究，通过支持遵守临床指南来减少护理过程中的差异。以前的研究受到小型、单一机构研究和选择偏差的限制；因此，本文将使用国家数据集以及倾向得分和多层次模型来检验CDSS对减少健康差距的真实治疗效果。

DESCRIPTION (provided by applicant): Health Information Technology (HIT) has been recommended as a means to lower health care costs, improve quality, and promote patient safety. One element of Health Information Technology that has helped improve quality of care is clinical decision support systems (CDSS). The proposed dissertation research will investigate the degree to which increased use of CDSS may contribute to reducing racial and rural/urban health quality disparities. Differences in process and outcome quality indicators will be studied by examining acute myocardial infarction (AMI) and pneumonia patients within hospitals with and without CDSS. Black and Hispanic patients have been shown to receive lower recommended care for these two conditions, and as a result suffer poorer health outcomes. Moreover, rural residents have been shown to receive lower recommended care for AMI as compared to their urban counterparts. This dissertation advances prior research by examining the potential for HIT systems, namely CDSS, to reduce disparities in processes of care by supporting adherence to clinical guidelines. Previous research has been limited by small, single-institution studies and selection biases; therefore, this dissertation will use national datasets along with propensity scores and multilevel models to examine the true treatment effect on reducing health disparities by CDSS. PUBLIC HEALTH RELEVANCE: Integrating health information technology research with examinations of healthcare quality offers an innovative direction for addressing disparities in care based on race and residence. The work proposed here will focus on the associations between use of CDSS to support evidence-based medicine and (1) hospital adherence to clinical guidelines and health outcomes as measured by Hospital Compare from the Centers for Medicare and Medicaid (CMS) and (2) outcome quality disparities for vulnerable patients as measured by the Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. Policy makers will be able to use the results of this study to strengthen the case for fully functional electronic medical record (EMR) systems that include clinical decision support systems (CDSS).