Reducing health disparities in primary care through a family medicine-library alliance

项目摘要/摘要 互联网和技术的快速发展极大地改变了健康信息的获取方式和 沟通。报告表明，全国范围内的互联网接入正在增加，更多的人可以获得医疗服务 在线信息已经与改进的健康知识和患者-提供者沟通(PPC)联系在一起。 除了广泛的Web访问之外，电子个人健康记录(PHR)的提供和使用还提供了 以患者为中心的方法，改善患者在其健康、购买力平价和最终护理质量方面的投资。 PHR增强护理对慢性病患者的益处的经验证据最强 需要自我管理的，如糖尿病和高血压，这些疾病由 没有得到充分服务的少数群体，造成了长期的健康差距。尽管有这些好处， 有证据还表明，数字鸿沟(即不平等的获取机会和使用技术方面的差距) 仍然存在于较低的社会经济地位、种族/少数民族和其他医疗服务不足的人群中 人口。这种鸿沟限制了可理解性和获取准确健康信息的途径，并阻碍了 有效的健康决策。此外，尽管智能手机拥有量很高，但通过 智能手机，以及不同种族/民族对接触PHR的兴趣增加--非白人仍然存在 登记和使用电子PHR的可能性大大降低。为了解决这些健康差距，我们 建议贝勒医学院(BCM)的马丁·路德·金与小马丁·路德·金建立创新伙伴关系。(MLK) 健康中心和著名的健康科学图书馆，休斯顿医学院-德克萨斯医学 中心(Ham-TMC)图书馆。MLK健康中心每年为40,000多名患者提供服务，主要是非洲人- 居住在德克萨斯州休斯敦哈里斯县中部的美国成年人。Ham-TMC图书馆是全国 最大的图书馆，并被国家医学图书馆指定为区域医学图书馆。 通过这个联盟，该项目将解决影响患者接近、使用和理解的因素 将以下列具体目标为指导：目标1：提高患者的知识， 使用来自网络的可靠、最新的健康信息来管理他们的护理的态度和技能；目标2： 建立现场健康信息学习中心，以增加获得高质量、有针对性的健康的机会 护理时的信息；目标3：增加患者对使用MyChart的掌握和信心 访问PHR，并在护理接触之间与提供者进行持续的、异步的通信。 这一提议的意义和改变的机会体现在以下事实上：大多数MLK患者 在线访问相关健康信息的权限有限，使用MyChart的比例约为10%，而 在同一城市的私人BCM家庭医学诊所，近90%的使用率，尽管MLK有更高的 多种慢性病的流行需要自我护理管理。我们的方法可以复制 或进行调整，以解决其他初级保健服务不足环境中的健康差距问题。

PROJECT SUMMARY/ABSTRACT Rapid advances in the internet and technology have greatly changed how health information is accessed and communicated. Reports indicate that internet access is increasing nationwide and greater access to health information online has been linked to improved health knowledge and patient-provider communication (PPC). In addition to generalized Web-access, availability and use of electronic personal health records (PHR) offers a patient-centric means of improving patient investment in their health, PPC, and ultimately the quality of care. Empirical evidence of benefits from PHR-enhanced care is strongest for patients with chronic diseases requiring self-management, such as diabetes and hypertension, conditions that are disproportionately borne by underserved minority populations and that contribute to persistent health disparities. Despite these benefits, evidence also suggests that a digital divide (i.e., inequitable access and disparities in the use of technology) still exists among the lower socioeconomic status, racial/ethnic minority, and other medically underserved populations. This divide limits comprehensibility and access to accurate health information and hinders effective health decision making. Also, despite high smartphone ownership, frequent access of the Internet via smartphones, and increased interest in access to PHRs across racial/ethnic groups—nonwhites remain significantly less likely to register for and utilize electronic PHRs. To address these health disparities, we propose an innovative partnership between Baylor College of Medicine’s (BCM) Martin Luther King, Jr. (MLK) Health Center and a prominent health sciences library, the Houston Academy of Medicine-Texas Medical Center (HAM-TMC) Library. The MLK Health Center serves over 40,000 patients each year, primarily African- American adults residing in central Harris County, Houston, TX. The HAM-TMC library is one of the nation’s largest libraries and has been designated as a Regional Medical Library by the National Library of Medicine. Through this alliance, the project will address influential factors in patients’ access, use, and understandability of health information, and will be guided by the following specific aims: Aim 1: To improve patients’ knowledge, attitudes, and skills in using reliable, up-to-date health information from the Web to manage their care; Aim 2: To establish an on-site ‘health information learning center’ to increase access to high-quality, targeted health information at the point of care; and Aim 3: To increase patients’ mastery and confidence in using MyChart to access PHRs and engage in ongoing, asynchronous communication with providers between care encounters. This proposals’ significance and opportunity for change is exemplified by the fact that most MLK patients have limited access to relevant health information online and approximately 10% use MyChart, compared to nearly 90% usage at a private BCM family medicine clinic within the same city, despite MLK having a higher prevalence of multiple chronic conditions necessitating self-care management. Our approach can be replicated or adapted to address health disparities in other underserved primary care settings.