Massachusetts Health Disparities Monitoring System

描述(由申请人提供)： 心血管健康方面的种族、民族、性别、语言、社会经济和地理差异都有很好的记录，这是一个引起巨大公共卫生关注的原因。传统的以人群为基础的监测差异的方法不足以理解各种对健康的影响之间的因果关系。需要更详细的临床和卫生信息，以了解与卫生相关的政策和改革如何影响差异。马萨诸塞州(马萨诸塞州)是美国医疗改革中最重要的自然实验之一的现场，也是监测和评估与此类政策变化相关的心血管疾病(CVD)和风险因素差异以及当前经济低迷造成的差异的理想环境。我们建议开发一个广泛的、可识别的、易于访问的数据库，其中包括有关儿童和成人居民的临床数据，这些数据来自：1)新英格兰最大的安全网医院波士顿医疗中心及其附属社区健康中心；2)另一个大型学术三级保健系统，位于马萨诸塞州中部的马萨诸塞大学医疗中心，其患者人口更多的是白人和中产阶级；以及3)来自BMC Health Plan的索赔数据，该计划是全州最大的低收入个人新保险产品提供商。我们将使用i2b2，这是一个开源、可扩展的信息学平台，提供了广泛的翻译信息学工具，包括临床数据存储库和标准本体。I2b2的S数据结构、本体和查询(分析)工具允许集成和分析来自不同系统的大量未识别数据，并在使用临床数据进行差异监控的能力方面取得了根本性的进步。此外，所有i2b2系统共享一个公共架构；数据、查询和软件工具可以在系统之间共享，以支持机构间的差异研究。我们将测试应用这一新资源对常见心血管疾病风险因素和慢性疾病进行差异监测的可行性，这些因素导致大量发病率和死亡率，其中存在已知差异，并且HP2010国家公共卫生目标试图改善这些差异：高血压、高脂血症、肥胖/超重和烟草使用。我们有三个主要目标：1)开发一个强大的基础设施，以监测心血管疾病的风险因素和结果。使用i2b2，我们将创建一个大型的、纵向的、全州范围的非身份识别数据库，并开发新的软件工具和资源来监测和分析儿童和成人的健康差距；2)探索医疗改革和经济低迷对健康结果差异的影响。我们将研究改革前和改革后时期以及当前经济低迷之前和之后时期医疗保险覆盖面的变化和健康差距；3)制定战略，向政策制定者、医疗保健提供者和研究界分享工具和交流结果。 公共卫生相关性： 项目简介我们提议的项目将创建一个独特的、集成的数据系统，通过它来监测和评估健康差距。我们将提供的差异监测数据可用于观察当地，甚至社区层面的差异随时间的变化，检查政策变化的影响，并更好地了解筛查和接受护理与差异的关系。我们预计的国家影响将来自我们开发的程序和工具，这些程序和工具可以在全国范围内分享和实施，供其他州对其环境中的差异进行类似详细的监测。

DESCRIPTION (provided by applicant): Racial, ethnic, gender, language, socioeconomic, and geographic disparities in cardiovascular health are well documented, and a cause for great public health concern. Traditional population-based methods of monitoring disparities are inadequate for understanding the causal pathways among the myriad of influences on health. More detailed clinical and health information is needed to understand how health-related policies and reforms affect disparities. Massachusetts (MA) is the scene of one of the most significant natural experiments in health reform in the nation, and is the ideal setting in which to monitor and evaluate the cardiovascular disease (CVD) and risk factor disparities associated with such policy changes, in addition to those wrought by the current economic downturn. We propose to develop an extensive, de-identified, easily accessible database including information about child and adult residents using clinical data from:1) New England's largest safety net hospital, Boston Medical Center, and its affiliated community health centers; 2) another large academic tertiary care system, University of Massachusetts Medical Center in central MA whose patient population is more white and middle class; and 3) claims data from the BMC Health Plan, the largest statewide provider of the new insurance product for low income individuals. We will use i2b2, an open-source, scalable informatics platform offering a broad array of translational informatics tools including a clinical data repository and a standard ontology. I2b2's data structure, ontology, and query (analytic) tools allow the integration and analysis of massive amounts of de-identified data from disparate systems, and present a radical advance in the ability to use clinical data for disparities monitoring. Furthermore, all i2b2 systems share a common architecture; data, queries, and software tools can be shared between systems to support inter-institutional disparities research. We will test the feasibility of applying this novel resource for disparities monitoring for common CVD risk factors and chronic conditions which lead to substantial morbidity and mortality, where there are known disparities, and which the national public health goals of HP2010 seek to improve: hypertension, hyperlipidemia, obesity/overweight, and tobacco use. We have three primary aims: 1) Develop a powerful infrastructure to monitor CVD risk factors and outcomes. Using i2b2, we will create a large, longitudinal, statewide de-identified database, and develop new software tools and resources to monitor and analyze pediatric and adult health disparities; 2) Explore the effects of health reform and the economic downturn on disparities in health outcomes. We will examine changes in health insurance coverage and health disparities during pre- and post-reform periods, and periods before and into the current economic downturn; 3) Develop strategies for sharing tools and communicating results to policy makers, health care providers, and the research community. PUBLIC HEALTH RELEVANCE: Project Narrative Our proposed project will create a unique, integrated data system by which to monitor and evaluate health disparities. The disparities monitoring data we will provide access to can be used to observe local, even community level, changes in disparities over time, examine the impact of policy changes, and better understand how screening and receipt of care are related to disparities. The national impact we anticipate will come from the process and tools we develop, which can be shared and implemented nationally for other states to conduct similarly detailed monitoring of disparities in their settings.