Improving healthcare quality with user-centric patient portals

描述（由申请人提供）：以患者为中心的护理包括尊重患者的价值观和偏好，跨护理环境的协调，文化能力，有效的沟通和患者教育。为了实现以患者为中心的护理，患者需要个性化、及时和可理解的医疗信息。这些需求可能会得到电子病人门户网站和个人健康记录等技术的支持，鉴于卫生与公众服务部2010年鼓励“有意义地使用”卫生信息技术（IT）的规定，这些技术可能会变得更加普遍。消费者医疗信息技术已经证明了对许多结果的有效性，但尚未在实践中证明对医疗保健质量的广泛影响。技术影响模型表明，这是因为这些技术没有广泛传播，用户没有以最佳方式使用它们。采用和使用的障碍包括诸如计算机知识、互联网接入、可用性、卫生知识和计算能力等因素，有时技术侧重于实现组织目标而不是患者目标。我们认为，潜在有益的消费者技术只有在被广泛采用和使用后，才会提高医疗保健质量，而只有当技术与患者的能力和需求相匹配时，这种采用率才会上升。我们还建议，成功地将技术与患者需求相匹配，需要更深入地了解患者对健康信息和信息管理的需求。该提案描述了一个研究议程，用于开发和验证患者信息需求模型，将其应用于改进患者门户的采用，并评估使用这些门户对医疗保健质量的影响。本研究的长期目标是使患者在管理其健康和医疗保健方面发挥核心作用，并定量评估其效果。在本提案中描述的第一项研究使用定性方法来开发患者信息管理需求框架。第二项研究用来自患者门户网站的定量使用数据验证了该框架。第三项研究采用人为因素方法，提高门户网站的可用性和满足患者信息管理需求的能力。最后一项研究将比较门户用户和非用户在一段时间内所经历的护理质量。这项工作以及本提案中概述的培训目标将推动消费者健康信息技术领域的发展，并使Jessica Ancker博士成为信息学和卫生服务研究交叉领域的独立研究员。

DESCRIPTION (provided by applicant): Patient-centered care involves respect for patients' values and preferences, coordination across care settings, cultural competency, effective communication, and patient education. To achieve patient-centered care, patients need personalized, timely, and understandable medical information. These needs could potentially be supported by technologies such as electronic patient portals and personal health records, which are likely to become more common in light of the Department of Health and Human Services' 2010 rule to encourage "meaningful use" of health information technology (IT). Consumer health IT has demonstrated efficacy for a number of outcomes, but has not yet demonstrated broad impact on healthcare quality in practice. Models of technology impact suggest that this is because the technologies have not diffused broadly and users are not using them optimally. Barriers to adoption and use include such factors as computer literacy, Internet access, usability, health literacy and numeracy, and sometimes a technology focus on meeting organizational goals rather than patient goals. We propose that potentially beneficial consumer technologies will improve healthcare quality only after they are widely adopted and used, and that adoption will rise only when the technologies match both patient abilities and their needs. We additionally propose that successfully matching technologies to patient needs requires a deeper understanding of patient needs for health information and information management. This proposal describes a research agenda to develop and validate a model of patient information needs, apply it to improve adoption of patient portals, and assess the effect of use of these portals on healthcare quality. The long-term goal of this research is to empower patients to assume a central role in the management of their health and health care, and quantitatively evaluate the effect. The first study described in this proposal uses qualitative methods to develop a patient information management needs framework. The second study validates this framework with quantitative usage data from patient portals. The third study employs human factors methods to improve the portals' usability and ability to meet patient information management needs. The final study will compare quality of care experienced by portal users and nonusers over time. This work, along with the training goals outlined in this proposal, will advance the field of consumer health information technology and position Dr. Jessica Ancker as an independent researcher at the intersection of informatics and health services research.