Shared Medical Records and Chronic Illness Care

描述（由申请人提供）：在糖尿病和慢性疾病护理中，患者和提供者之间有效、持续的沟通是一个重要组成部分。患有糖尿病和多种慢性疾病的患者尤其依赖于与主治医生的有效沟通，以激励和解决护理问题。不幸的是，我们目前的医疗保健系统的重点门诊访问不能满足这些患者的需求。使用患者门户网站的慢性病护理提供了一个机会，可以将医疗保健的重点从办公室转移到患者的日常生活中。我们建议评估糖尿病患者慢性病护理质量与患者和医疗保健提供者之间共享的基于网络的交互式电子病历的使用之间的关系。为了实现这一目标，我们将研究一个大型的、安全的患者门户网站，在集团健康合作社（Group Health）的自然环境中进行护理。GroupHealth的门户网站MyGroupHealth允许参保者：1)与包括医生在内的整个医疗团队交换电子信息；2)实时访问其电子病历；3)获取访问后摘要，并嵌入到Healthwise知识库的超链接；4)通过直接运送到患者家中获取药品的补充；5)安排与供应商的办公室预约；6)获得量身定制的健康教育信息，并与他们的具体健康状况相联系。该研究将重点关注糖尿病和一种或多种其他慢性疾病患者的初级保健。在回顾性分析中，我们将首先评估门户采用的预测因素，以及电子门户的使用是否与更好的临床护理质量相关。在该队列的一个子样本的横断面调查中，我们将评估门户网站的使用是否与更好的初级保健关系、患者激活和患者对慢性病护理的评估有关。通过内容分析，我们将评估患者-提供者安全信息和患者访后总结的质量是否与更好的慢性疾病护理相关。最后，通过对患者和他们的初级保健提供者的定性访谈，我们将试图了解Web门户网站满足和未能满足患者需求的地方。这项研究的结果将有助于开发、评估和传播旨在支持糖尿病和多种合并症患者护理的患者门户网站。

DESCRIPTION (provided by applicant): Effective, ongoing communication between patients and providers is an important component of diabetes and chronic illness care. Patients with diabetes and multiple chronic conditions are particularly dependent on effective communication with a primary physician over time to motivate and troubleshoot care. Unfortunately, our current health care system's focus on the clinic visit does not meet the needs of these patients. Chronic disease care using patient Web portals offers an opportunity to shift the focus in health care away from the office and toward patients' daily lives at home. We propose to evaluate the association between the quality of chronic illness care among patients with diabetes and the use of a Web-based, interactive electronic medical record shared between patients and health care providers. To achieve this goal, we will study a large and secure patient Web portal in the natural setting of care at Group Health Cooperative (Group Health). Group Health's Web portal, MyGroupHealth, allows enrollees to: 1) exchange electronic messages with their entire health care team including physicians; 2) access their electronic medical records in real time; 3) obtain after-visit summaries with embedded hyperlinks to the Healthwise knowledge base; 4) obtain refills on medications with shipping directly to patients' homes; 5) schedule office appointments with providers; and 6) access health education information that is tailored and linked to their specific health conditions. The study will focus on the primary care of patients with diabetes and one or more other chronic conditions. In retrospective analyses, we will first evaluate predictors of portal adoption and whether use of the electronic portal is associated with better clinical quality of care. In a cross-sectional survey of a subsample of this cohort, we will then evaluate whether portal use is associated with better primary care relationships, patient activation and patient's assessment of chronic illness care. Through content analysis, we will evaluate whether the qualities of patient-provider secure messages and patients' after-visit summaries are associated with better chronic illness care. Finally, through qualitative interviews of patients and their primary care providers, we will seek to understand where the Web portal meets and fails to meet patients' needs. Results of this study will help inform the development, evaluation and dissemination of patient Web portals designed to support the care of patients with diabetes and multiple co-morbidities.