Massachusetts Health Disparities Monitoring System

马萨诸塞州健康差异监测系统

• 批准号: 7941919
• 负责人: WILLIAM G ADAMS
• 金额: $ 167.35万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2012-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7941919
• 关键词: Adult; Affect; Architecture; Behavioral; Biological; Biology; Boston; Cardiovascular Diseases; Cardiovascular system; Caring; Child; Childhood; Chronic; Clinical; Clinical Data; Communities; Community Health Centers; Complex; Computer software; Data; Databases; Economics; Epidemiology; Funding; Funding Mechanisms; Future; Gender; Goals; Health; Health Insurance; Health Insurance Portability and Accountability Act; Health Personnel; Health Planning Organizations; Health Policy; Healthcare Systems; Hospitals; Hyperlipidemia; Hypertension; Individual; Informatics; Information Systems; Institutes; Institution; Insurance; Insurance Carriers; Insurance Coverage; Interdisciplinary Study; Language; Lead; Life Style; Low income; Massachusetts; Medical center; Methods; Modification; Monitor; Morbidity - disease rate; Natural experiment; New England; Obesity; Ontology; Outcome; Overweight; Pathway interactions; Patients; Policies; Policy Maker; Preventive screening; Privacy; Process; Provider; Public Health; Public Policy; Research; Research Ethics Committees; Research Infrastructure; Resources; Risk Factors; Screening procedure; Security; Software Tools; Surveys; System; Testing; Time; Tobacco use; Translational Research; United States National Institutes of Health; Universities; Work; biomedical informatics; cardiovascular disorder risk; care systems; data integration; data sharing; data structure; database structure; experience; genetic epidemiology; health disparity; improved; innovation; member; mortality; novel; open source; patient population; population based; prevent; public health relevance; racial and ethnic; safety net; social; socioeconomics; tertiary care; tool

DESCRIPTION (provided by applicant): Racial, ethnic, gender, language, socioeconomic, and geographic disparities in cardiovascular health are well documented, and a cause for great public health concern. Traditional population-based methods of monitoring disparities are inadequate for understanding the causal pathways among the myriad of influences on health. More detailed clinical and health information is needed to understand how health-related policies and reforms affect disparities. Massachusetts (MA) is the scene of one of the most significant natural experiments in health reform in the nation, and is the ideal setting in which to monitor and evaluate the cardiovascular disease (CVD) and risk factor disparities associated with such policy changes, in addition to those wrought by the current economic downturn. We propose to develop an extensive, de-identified, easily accessible database including information about child and adult residents using clinical data from:1) New England's largest safety net hospital, Boston Medical Center, and its affiliated community health centers; 2) another large academic tertiary care system, University of Massachusetts Medical Center in central MA whose patient population is more white and middle class; and 3) claims data from the BMC Health Plan, the largest statewide provider of the new insurance product for low income individuals. We will use i2b2, an open-source, scalable informatics platform offering a broad array of translational informatics tools including a clinical data repository and a standard ontology. I2b2's data structure, ontology, and query (analytic) tools allow the integration and analysis of massive amounts of de-identified data from disparate systems, and present a radical advance in the ability to use clinical data for disparities monitoring. Furthermore, all i2b2 systems share a common architecture; data, queries, and software tools can be shared between systems to support inter-institutional disparities research. We will test the feasibility of applying this novel resource for disparities monitoring for common CVD risk factors and chronic conditions which lead to substantial morbidity and mortality, where there are known disparities, and which the national public health goals of HP2010 seek to improve: hypertension, hyperlipidemia, obesity/overweight, and tobacco use. We have three primary aims: 1) Develop a powerful infrastructure to monitor CVD risk factors and outcomes. Using i2b2, we will create a large, longitudinal, statewide de-identified database, and develop new software tools and resources to monitor and analyze pediatric and adult health disparities; 2) Explore the effects of health reform and the economic downturn on disparities in health outcomes. We will examine changes in health insurance coverage and health disparities during pre- and post-reform periods, and periods before and into the current economic downturn; 3) Develop strategies for sharing tools and communicating results to policy makers, health care providers, and the research community. PUBLIC HEALTH RELEVANCE: Project Narrative Our proposed project will create a unique, integrated data system by which to monitor and evaluate health disparities. The disparities monitoring data we will provide access to can be used to observe local, even community level, changes in disparities over time, examine the impact of policy changes, and better understand how screening and receipt of care are related to disparities. The national impact we anticipate will come from the process and tools we develop, which can be shared and implemented nationally for other states to conduct similarly detailed monitoring of disparities in their settings.

描述（由申请人提供）： 心血管健康方面的种族、民族、性别、语言、社会经济和地理差异有据可查，是引起极大公共卫生关注的原因。传统的以人口为基础的监测差异的方法不足以理解对健康的无数影响中的因果途径。需要更详细的临床和健康信息，以了解与健康有关的政策和改革如何影响差距。 马萨诸塞州（MA）是美国卫生改革中最重要的自然实验之一，是监测和评估心血管疾病（CVD）和与此类政策变化相关的风险因素差异的理想环境，此外还有当前经济衰退造成的差异。我们建议开发一个广泛的、去识别的、易于访问的数据库，包括使用以下临床数据的儿童和成人居民的信息：1）新英格兰最大的安全网医院，波士顿医疗中心及其附属社区卫生中心; 2）另一个大型学术三级医疗系统，位于MA中部的马萨诸塞州大学医疗中心，其患者人群更多是白色和中产阶级;以及3）来自BMC健康计划的索赔数据，BMC健康计划是全州最大的低收入个人新保险产品提供商。 我们将使用i2 b2，一个开源的，可扩展的信息学平台，提供了广泛的翻译信息学工具，包括临床数据库和标准本体。I2 b2的数据结构、本体和查询（分析）工具允许集成和分析来自不同系统的大量去识别数据，并在使用临床数据进行差异监测的能力方面取得了根本性的进步。此外，所有的i2 b2系统共享一个共同的架构;数据，查询和软件工具可以在系统之间共享，以支持机构间的差异研究。我们将测试应用这种新资源的可行性差异监测常见的心血管疾病的危险因素和慢性疾病，导致大量的发病率和死亡率，其中有已知的差距，并在国家公共卫生目标的HP 2010年寻求改善：高血压，高脂血症，肥胖/超重，和烟草使用。 我们有三个主要目标：1）开发一个强大的基础设施，以监测心血管疾病的风险因素和结果。使用i2 b2，我们将创建一个大型的，纵向的，全州去识别数据库，并开发新的软件工具和资源，以监测和分析儿科和成人健康差距; 2）探索卫生改革和经济衰退对健康结果差距的影响。我们将研究改革前后以及当前经济衰退之前和之后的健康保险覆盖范围和健康差距的变化; 3）制定与政策制定者，医疗保健提供者和研究团体共享工具和交流结果的战略。 公共卫生关系： 项目叙述我们拟议的项目将创建一个独特的综合数据系统，通过该系统监测和评估健康差距。我们将提供访问的差异监测数据可用于观察地方，甚至社区一级的差异随时间的变化，检查政策变化的影响，并更好地了解筛查和接受护理与差异的关系。我们预期的国家影响将来自我们开发的过程和工具，这些过程和工具可以在全国范围内共享和实施，以便其他国家对其环境中的差异进行类似的详细监测。

项目成果

Clinical Operations Variables are Associated With Blood Pressure Outcomes.

• DOI: 10.1097/mlr.0000000000000349
• 发表时间: 2015-06
• 期刊: Medical care
• 影响因子: 3
• 作者: Kressin NR;Lasser KE;Paasche-Orlow M;Allison J;Ash AS;Adams WG;Shanahan CW;Legler A;Pizer SD
• 通讯作者: Pizer SD