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

描述（由申请人提供）：本研究将使用大型集成交付系统（IDS）中的自然实验（2004-2012），研究市售集成医疗IT系统如何影响糖尿病患者的质量和资源使用。我们将采用准实验性的前后设计，利用2004-2008年门诊综合健康IT系统和2006-2010年住院部分的交错实施。全面的健康IT系统包括集成了订单输入、决策支持和患者门户的电子健康记录;以前的系统主要基于纸质病历。IDS现有的自动化数据库将为本研究提供数据，并允许在新的健康IT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IDS内1，028名初级保健提供者、167名专业临床医生（心脏病学家、内分泌学家、肺病学家）、21名Eds和18个医疗中心的177，000名糖尿病患者。主要预测因素是患者提供者对健康信息技术的使用。质量结果指标包括糖尿病和其他四种慢性疾病（哮喘、CAD、CHF和HTN）的指南依从性处方药使用和实验室监测、药物依从性和生理疾病控制（通过实验室检查测量）。资源使用结果指标包括门诊就诊、急诊就诊、非择期住院。使用随机效应模型，我们将测试的假设，卫生IT的使用与提高质量和降低就诊率。我们将有很好的统计能力来检测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、成本分摊和护理提供结构。我们的研究问题在全国范围内广泛适用，特别是考虑到对健康IT的高度兴趣，以及迫切需要改善患者护理质量和患者医疗保健资源使用。 公共卫生相关性：健康IT具有改变临床护理的巨大潜力，特别是对于不断增长的糖尿病患者，其中许多人有复杂的医疗保健需求。在大型交付系统中实施集成的健康IT系统创造了一个独特的自然实验和一个宝贵的机会，以调查和量化其对糖尿病患者护理质量的影响。我们的研究问题健康IT对质量和资源利用的影响是广泛适用于全国各地，特别是考虑到健康IT的高度兴趣，以及迫切需要改善病人护理的质量，并在病人的医疗保健资源的使用。

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.