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

访问、管理和理解个人健康信息的能力使个人能够成为更好的消费者，并更充分地参与医疗保健决策。 电子健康记录的发展和访问个人健康记录的患者门户网站的可用性，加上通过互联网（电子健康）的无数健康信息，提供了电子个人健康信息管理（ePHIM）的潜力。 然而，美国人口的组成部分在获得电子健康信息方面存在很大的差异。尽管不断努力，但农村、少数民族和低收入社区仍然存在这种“数字鸿沟”。 ePHIM服务有限，加剧了这些人群的健康差距。 该项目的目标是改善 生活在农村和城市社区的低收入非裔美国人、美洲印第安人、拉丁美洲人和白色老年人使用信息技术应用程序进行ePHIM的能力。 该项目的概念框架结合了技术接受模型和人-环境相互作用模型。 它利用维克森林医学院及其门诊部医学诊所的社区参与式伙伴关系，与社区合作伙伴健康网，一个由18个诊所组成的网络，服务于25个北卡罗来纳州农村县，以实现3个具体目标：（1）记录ePHIM的经验，知识，感知的需求，以及低收入非洲裔美国人，美洲印第安人，拉丁美洲人，和居住在农村和城市社区的白色老年人~（2）描述居住在农村和城市社区的低收入非裔美国人、美洲印第安人、拉丁美洲人和白色老年人对ePHIM的实际使用情况~和（3）描述使用ePHIM与不使用ePHIM的患者和护理人员在使用ePHIM方面的感知、信念和经验差异。 该项目意义重大，因为它将通过与两个诊所网络（社区合作伙伴健康网~门诊部医学诊所/维克森林浸礼会健康）合作，为农村和城市、低收入和少数民族患者提供护理，从而划定ePHIM中的差距。 本项目将与这些网络合作，进行深入和纵向的研究，以确定影响弱势长者使用ePHIM的因素。 这个项目是创新的。 (1)它将在以社区为基础的参与性研究框架内使用定性数据收集技术，以评估农村以及城市、低收入、老年人和少数民族社区中患者和护理人员ePHIM的动机和障碍。 (2)它强调了包括照顾者，特别是老年人，在理解使用ePHIM的重要性。 (3)它将使用这些定性方法来评估医疗保健提供者和IT提供者对ePHIM潜在用途的看法。 (4)它将使用这些定性方法来确定促进和限制使用 ePHIM通过比较高/专家，中等和低用户。 (5)它将记录一年内老年人及其照顾者使用ePHIM的实际模式。 (6)它将探讨老年人中ePHIM使用和慢性疾病管理的关联。

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.