Maximizing the Impact of ePHIM in Low-Income, Multiethnic Populations

描述（由申请人提供）：访问、管理和理解个人健康信息的能力使个人成为更好的消费者，并更充分地参与制定医疗保健决策。电子健康记录的发展和访问个人健康记录的病人门户的可用性，加上通过互联网（电子健康）提供的无数健康信息，为电子个人健康信息管理（ePHIM）提供了潜力。然而，对于美国人口的组成部分，在获取电子健康信息方面存在很大的差异。尽管不断努力，这种“数字鸿沟”仍然存在于农村、少数民族和低收入社区。ePHIM获得机会有限，造成了这些人群所经历的健康差异。这个项目的目标是改进

DESCRIPTION (provided by applicant): The ability to access, manage, and understand personal health information enables individuals to become better consumers and participate more fully in making health care decisions. The development of electronic health records and the availability of patient portals for accessing personal health records, coupled with myriad health information via the internet (eHealth), have provided the potential for electronic personal health information management (ePHIM). However, great variability exists in access to eHealth information for components of the US population. Despite continuing efforts, this "digital divide" remains for rural, minority and low-income communities. Limited access for ePHIM contributes to the health disparities experienced by these populations. The goal of this project is to improve the ability of low-income African American, American Indian, Latino, and white older adults living in rural and urban communities to use information technology applications for ePHIM. The project's conceptual framework combines the Technology Acceptance Model and the person- environmental interaction model. It uses a community-based participatory partnership of Wake Forest School of Medicine and its Outpatient Department Medicine Clinic, with Community Partners HealthNet, a network of 18 clinics serving 25 rural North Carolina counties, to achieve 3 specific aims: (1) document the ePHIM experience, knowledge, perceived needs, and perceived risks of low-income African American, American Indian, Latino, and white older adults living in rural and urban communities~ (2) delineate the actual use of ePHIM by low-income African American, American Indian, Latino, and white older adults living in rural and urban communities~ and (3) delineate differences in perception, belief and experience in using ePHIM between patients and caregivers who use versus those who do not use ePHIM. This project is significant because it will delineate disparities in ePHIM by working with two networks of clinics (Community Partners HealthNet~ Outpatient Department Medicine Clinic/Wake Forest Baptist Health) that provides care to rural and urban, low- income, and minority patients. Working with these networks, this project will implement in-depth and longitudinal research that will delineate the factors affecting ePHIM use among vulnerable elders. This project is innovative. (1) It will use qualitative data collection techniques within a community-based participatory research framework to assess the motives and barriers to patients' and caregivers' ePHIM among rural as well as urban, low-income, older adult, and minority communities. (2) It emphasizes the importance of including caregivers, particularly for older adults, in understanding the use of ePHIM. (3) It will use these qualitative methods to assess the perceptions of health care providers and IT providers about the potential use of ePHIM. (4) It will use these qualitative methods to determine the factors that facilitated and limited the use of ePHIM by comparing high / expert, medium, and low users. (5) It will document the actual pattern of ePHIM use among older adults and their caregivers over a one-year period. (6) It will explore the association of ePHIM use and chronic disease management among older adults.