Impact of Integrated Health IT on Quality and Resource Use for Diabetic Patients

描述(由申请人提供)：这项研究将使用一个大型综合交付系统(IDS)内的自然实验(2004-2012)，研究商业上可用的综合医疗信息技术系统如何影响糖尿病患者的质量和资源使用。我们将使用准试验性的岗位前设计，该设计利用了在2004-2008年间交错实施综合门诊健康信息技术系统，以及在2006-2010年间交错实施住院部分。全面的Health IT系统包括与订单输入、决策支持和患者门户集成的电子健康记录；以前的系统主要基于纸质医疗记录。入侵检测系统现有的自动化数据库将为这项研究提供数据，并允许在新的卫生信息技术系统之前和之后一致地捕获我们的结果和患者水平的协变量。我们将重点关注来自1,028个初级保健提供者、167名专业临床医生(心脏病专家、内分泌科医生、肺科医生)、21个急诊室和18个医疗中心的177,000名糖尿病患者。主要的预测因素是患者提供者对Health IT的使用。质量结果衡量标准包括遵循指南的处方药使用和实验室监测、药物依从性以及糖尿病和其他四种慢性病(哮喘、冠心病、CHF和HTN)的生理性疾病控制(由实验室测试衡量)。资源利用结果指标包括门诊就诊、急诊科就诊、非选择性住院。使用随机效应模型，我们将检验卫生信息技术的使用与质量的提高和就诊率的降低相关的假设。我们将拥有出色的统计能力，能够发现我们结果中的微小变化。我们将根据患者、保险和组织因素进行调整，包括社会经济地位、病例组合、费用分担和护理提供结构。我们的研究问题广泛适用于全国各地，特别是考虑到对医疗IT的高度兴趣，以及患者护理质量和患者医疗资源使用方面的迫切需要。 公共卫生相关性：卫生信息技术具有改变临床护理的引人注目的潜力，特别是对于日益增长的糖尿病患者，他们中的许多人都有复杂的医疗保健需求。在一个大型交付系统中实施集成的健康信息技术系统创造了一个独特的自然实验，并提供了一个宝贵的机会来调查和量化其对糖尿病患者护理质量的影响。我们关于医疗IT对质量和资源使用的影响的研究问题在全国范围内广泛适用，特别是考虑到对医疗IT的高度兴趣，以及患者护理质量和患者医疗资源使用的迫切需要。

DESCRIPTION (provided by applicant): This study will examine how a commercially available integrated health IT system impacts quality and resource use for patients with diabetes, using a natural experiment (2004-2012) within a large integrated delivery system (IDS). We will use a quasi- experimental pre-post design, which exploits the staggered implementation of integrated outpatient Health IT system between 2004-2008, and of the inpatient component between 2006-2010. The comprehensive Health IT system includes an electronic health record integrated with order-entry, decision-support, and a patient portal; the prior system was primarily based on a paper medical record. The IDS's existing automated databases will provide the data for this study and permit consistent capture of our outcomes and patient-level covariates both before and after the new Health IT system. We will focus on a cohort of 177,000 patients with diabetes across 1,028 primary care providers, 167 specialty clinicians (cardiologists, endocrinologists, pulmonologists), 21 Eds, and 18 medical centers within the IDS. The main predictor is use of Health IT by a patient's providers. The quality outcome measures include guideline-adherent prescription drug use and laboratory monitoring, drug adherence, and physiologic disease control (measured by laboratory tests) for diabetes and any of four other chronic diseases (Asthma, CAD, CHF, and HTN). The resource use outcome measures include outpatient visits, emergency department visits, non-elective hospitalizations. Using random effect models, we will test the hypotheses that Health IT use is associated with improved quality and lower visit rates. We will have excellent statistical power to detect small changes in our outcomes. We will make adjustments for patient, insurance, and organizational factors, including socio-economic status, case-mix, cost-sharing, and care delivery structure. Our research questions are broadly applicable across the nation, especially given high interest in Health IT, and the urgent need for improvements in the quality of patient care, and in patient healthcare resource use. PUBLIC HEALTH RELEVANCE: Health IT has compelling potential to transform clinical care, especially for the growing population of patients with diabetes, many of whom have complex healthcare needs. The implementation of an integrated Health IT system across a large delivery system creates a unique natural experiment and a valuable opportunity to investigate and quantify its effects on quality of care for patients with diabetes. Our research questions about Health IT effects on quality and resource use are broadly applicable across the nation, especially given high interest in Health IT, and the urgent need for improvements in the quality of patient care, and in patient healthcare resource use.