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用于访问个人健康记录的患者门户的可用性，再加上通过互联网(EHealth)获得的大量健康信息，为电子个人健康信息管理(EPHIM)提供了潜力。然而，美国部分人口在获取电子健康信息方面存在很大的差异。尽管作出了持续的努力，但农村、少数民族和低收入社区仍然存在这种“数字鸿沟”。EPHIM获得的机会有限，导致这些人口经历了健康差距。这个项目的目标是改进 居住在农村和城市社区的低收入非裔美国人、美国印第安人、拉丁裔和白人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-环境交互模型。它利用维克森林医学院及其门诊部医学诊所与社区伙伴HealthNet的社区参与式合作伙伴关系，社区伙伴HealthNet是一个由18个诊所组成的网络，服务于北卡罗来纳州的25个农村县，以实现3个具体目标：(1)记录居住在农村和城市社区的低收入非裔美国人、美国印第安人、拉丁裔和白人老年人的ePHIM经验、知识、感知需求和感知风险~(2)描述居住在农村和城市社区的低收入非洲裔、美国印第安人、拉丁裔和白人老年人实际使用ePHIM的情况~以及(3)描述感知上的差异使用ePHIM的患者和护理人员与不使用ePHIM的患者和照顾者之间使用ePHIM的信念和经验。该项目意义重大，因为它将通过与两个诊所网络(社区合作伙伴医疗网络~门诊部医学诊所/维克森林浸信会健康中心)合作，描述ePHIM中的差异，这两个网络为农村和城市、低收入和少数族裔患者提供护理。与这些网络合作，该项目将实施深入和纵向研究，描述影响弱势老年人使用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来评估农村和城市、低收入、老年人和少数族裔社区中患者和照顾者ePHIM的动机和障碍。(2)它强调了将照顾者包括在内的重要性，特别是对老年人来说，以了解ePHIM的使用。(3)它将使用这些定性方法来评估卫生保健提供者和信息技术提供者对ePHIM潜在使用的看法。(4)它将使用这些定性方法来确定促进和限制使用 通过比较高/专家、中等和低用户进行ePHIM。(5)它将记录老年人及其照顾者在一年期间使用ePHIM的实际模式。(6)它将探索ePHIM的使用与老年人慢性病管理的联系。

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.