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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) 已承认其致力于促进通过超过 300 亿美元的投资，广泛有意义地使用电子健康记录 (EHR) 来自 2009 年《经济和临床健康健康信息技术 (HITECH) 法案》的资金，通过 CMS 促进互操作性 (MPI) 计划。这项努力的潜在收益是通过在整个护理过程中及时传输电子健康信息来改善健康结果连续体。佛罗里达州医疗补助促进互操作性 (FMPI) 计划于 2011 年启动至 2021 年，但截至 2018 年，只有不到一半的医疗补助提供商证明了 EHR 的 MU（即高级 EHR 功能），可能会在该州造成先进使用“数字鸿沟”。 Medicaid/CHIP 为超过 8360 万人提供服务美国的受益人，其中许多人是传统上的低收入弱势群体多种合并症。因此，评估联邦资金是否旨在促进 MU 的采用至关重要是有效的，而不是无意中加剧卫生信息技术差距。该提案的总体目标是利用 FMPI 的数据来估计当地 EHR 的 MU 率和评估 EHR 的 MU 是否在传统上服务不足的地区高度集中的地区滞后人口。更具体地说，该提案的目标是：目标 1：估算低收入居民高度集中地区的 EHR MU 率；评估是否 MU 这些领域的利率滞后；并检查与这些地区的 MU 率相关的因素。目标 2：估算少数民族居民高度集中地区的 EHR MU 率；评估这些领域的 MU 率是否滞后；并检查与这些地区的 MU 率相关的因素。目标 3：估算农村地区和内城区 EHR 的 MU 率；评估 MU 率是否在这些方面滞后地区；并检查与这些地区的 MU 率相关的因素。我们将使用 FMPI 的 8748 项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 位国家提供者身份 (NPI) 和县标识符，该数据库将链接到来自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、聚类标准误差、未观察到的异质性“去偏法”、将使用赫克曼选择和分层广义线性模型（HGLM）。作为学术研究增强奖（AREA），我们将让研究生和本科生参与学生作为研究团队的重要成员，参与研究的各个方面，提供深入的接触和研究培训。我们将通过数字、印刷和演示论坛传播我们的研究成果， FAU 开放获取数字资源库、当地社区场所和同行评审期刊。