Reducing health disparities in primary care through a family medicine-library alliance

项目总结/摘要 互联网和技术的快速发展极大地改变了获取健康信息的方式， 沟通。报告表明，全国范围内的互联网接入正在增加， 在线信息已与改善健康知识和医患沟通联系在一起。 除了普遍的网络访问，电子个人健康记录（PHR）的可用性和使用提供了一个 以患者为中心的方法，改善患者对健康的投资，PPC，并最终提高护理质量。 经验证据表明，PHR增强护理对慢性病患者的益处最强 需要自我管理的疾病，如糖尿病和高血压， 少数民族人口得不到充分服务，并造成持续的健康差距。尽管有这些好处， 证据还表明，数字鸿沟（即，技术使用方面的不公平和差距） 在社会经济地位较低、种族/少数民族和其他医疗服务不足的人群中仍然存在 人口数量。这一鸿沟限制了准确卫生信息的可理解性和获取， 有效的健康决策。此外，尽管智能手机拥有率很高，但通过互联网频繁访问 智能手机，以及对跨种族/族裔群体获得PHR的兴趣增加-非白人仍然存在 登记和使用电子医生健康报告的可能性大大降低。为了解决这些健康问题，我们 建议贝勒医学院（Baylor College of Medicine）的马丁·路德·金（Martin Luther King，Jr.）（MLK） 健康中心和一个著名的健康科学图书馆，休斯顿医学院-得克萨斯州医学 中心（HAM-TMC）图书馆。MLK健康中心每年为40，000多名患者提供服务，主要是非洲人- 居住在德克萨斯州休斯顿哈里斯县中部的美国成年人。HAM-TMC图书馆是全国最大的图书馆之一， 它是世界上最大的图书馆，并被国家医学图书馆指定为区域医学图书馆。 通过这个联盟，该项目将解决影响患者访问，使用和理解的因素 的健康信息，并将遵循以下具体目标：目标1：提高病人的知识， 态度和技能，使用可靠的，最新的健康信息，从网上管理他们的照顾;目标2： 建立现场“健康信息学习中心”，以增加获得高质量、有针对性的健康信息的机会。 目标3：提高患者对使用MyChart的掌握程度和信心， 访问PHR，并在护理接触之间与提供者进行持续的异步通信。 这一建议的意义和改变的机会体现在大多数MLK患者 在线获取相关健康信息的渠道有限，约10%的人使用MyChart， 近90%的使用率在同一个城市的私人家庭医学诊所，尽管MLK有更高的 需要自我护理管理的多种慢性病的流行。我们的方法可以被复制 或适应于解决其他服务不足的初级保健环境中的健康差距。

PROJECT SUMMARY/ABSTRACT Rapid advances in the internet and technology have greatly changed how health information is accessed and communicated. Reports indicate that internet access is increasing nationwide and greater access to health information online has been linked to improved health knowledge and patient-provider communication (PPC). In addition to generalized Web-access, availability and use of electronic personal health records (PHR) offers a patient-centric means of improving patient investment in their health, PPC, and ultimately the quality of care. Empirical evidence of benefits from PHR-enhanced care is strongest for patients with chronic diseases requiring self-management, such as diabetes and hypertension, conditions that are disproportionately borne by underserved minority populations and that contribute to persistent health disparities. Despite these benefits, evidence also suggests that a digital divide (i.e., inequitable access and disparities in the use of technology) still exists among the lower socioeconomic status, racial/ethnic minority, and other medically underserved populations. This divide limits comprehensibility and access to accurate health information and hinders effective health decision making. Also, despite high smartphone ownership, frequent access of the Internet via smartphones, and increased interest in access to PHRs across racial/ethnic groups—nonwhites remain significantly less likely to register for and utilize electronic PHRs. To address these health disparities, we propose an innovative partnership between Baylor College of Medicine’s (BCM) Martin Luther King, Jr. (MLK) Health Center and a prominent health sciences library, the Houston Academy of Medicine-Texas Medical Center (HAM-TMC) Library. The MLK Health Center serves over 40,000 patients each year, primarily African- American adults residing in central Harris County, Houston, TX. The HAM-TMC library is one of the nation’s largest libraries and has been designated as a Regional Medical Library by the National Library of Medicine. Through this alliance, the project will address influential factors in patients’ access, use, and understandability of health information, and will be guided by the following specific aims: Aim 1: To improve patients’ knowledge, attitudes, and skills in using reliable, up-to-date health information from the Web to manage their care; Aim 2: To establish an on-site ‘health information learning center’ to increase access to high-quality, targeted health information at the point of care; and Aim 3: To increase patients’ mastery and confidence in using MyChart to access PHRs and engage in ongoing, asynchronous communication with providers between care encounters. This proposals’ significance and opportunity for change is exemplified by the fact that most MLK patients have limited access to relevant health information online and approximately 10% use MyChart, compared to nearly 90% usage at a private BCM family medicine clinic within the same city, despite MLK having a higher prevalence of multiple chronic conditions necessitating self-care management. Our approach can be replicated or adapted to address health disparities in other underserved primary care settings.