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

描述（由申请人提供）：本研究将使用大型综合输送系统（IDS）内的自然实验（2004-2012），研究商业上可用的综合医疗IT系统如何影响糖尿病患者的质量和资源使用。我们将使用准实验性的前后设计，利用2004-2008年间综合门诊医疗IT系统的交错实施，以及2006-2010年间住院部分的交错实施。全面的医疗IT系统包括一个集成了订单输入、决策支持和患者门户的电子健康记录；以前的系统主要是基于纸质医疗记录。IDS现有的自动化数据库将为这项研究提供数据，并允许在新的健康IT系统前后一致地捕获我们的结果和患者水平的协变量。我们将重点研究1028名初级保健提供者、167名专业临床医生（心脏病专家、内分泌专家、肺病专家）、21名急诊科医生和IDS内18个医疗中心的17.7万名糖尿病患者。主要的预测指标是患者医疗服务提供者对医疗信息技术的使用。质量结果测量包括糖尿病和其他四种慢性疾病（哮喘、冠心病、心力衰竭和HTN）中的任何一种的遵循指南的处方药使用和实验室监测、药物依从性和生理疾病控制（通过实验室测试测量）。资源利用结果测量包括门诊就诊、急诊就诊、非选择性住院。使用随机效应模型，我们将检验医疗信息技术的使用与提高质量和降低就诊率相关的假设。我们将有出色的统计能力来发现结果中的微小变化。我们将根据患者、保险和组织因素进行调整，包括社会经济状况、病例组合、费用分担和医疗服务结构。我们的研究问题在全国范围内广泛适用，特别是考虑到对医疗信息技术的高度兴趣，以及迫切需要提高患者护理质量和患者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.