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    Disparities in use of a personal health record in a managed care organization

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    Authors
    Roblin, Douglas W.
    Houston, Thomas K.
    Allison, Jeroan J.
    Joski, Peter J.
    Becker, Edmund R.
    UMass Chan Affiliations
    Department of Quantitative Health Sciences
    Document Type
    Journal Article
    Publication Date
    2009-09-02
    Keywords
    Adult
    *African Americans
    Cohort Studies
    Education
    *European Continental Ancestry Group
    Female
    Georgia
    *Health Records, Personal
    *Health Services Accessibility
    Humans
    Male
    Managed Care Programs
    Middle Aged
    Multivariate Analysis
    Patient Acceptance of Health Care
    Proportional Hazards Models
    Bioinformatics
    Biostatistics
    Epidemiology
    Health Services Research
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    Link to Full Text
    http://dx.doi.org/10.1197/jamia.M3169
    Abstract
    OBJECTIVE: Personal health records (PHRs) can increase patient access to health care information. However, use of PHRs may be unequal by race/ethnicity. DESIGN: The authors conducted a 2-year cohort study (2005-2007) assessing differences in rates of registration with KP.org, a component of the Kaiser Permanente electronic health record (EHR). MEASUREMENTS: At baseline, 1,777 25-59 year old Kaiser Permanente Georgia enrollees, who had not registered with KP.org, responded to a mixed mode (written or Internet) survey. Baseline, EHR, and KP.org data were linked. Time to KP.org registration by race from 10/1/05 (with censoring for disenrollment from Kaiser Permanente) was adjusted for baseline education, comorbidity, patient activation, and completion of the baseline survey online vs. by paper using Cox proportional hazards. RESULTS: Of 1,777, 34.7% (616) registered with KP.org between Oct 2005 and Nov 2007. Median time to registering a KP.org account was 409 days. Among African Americans, 30.1% registered, compared with 41.7% of whites (p < 0.01). In the hazards model, African Americans were again less likely to register than whites (hazard ratio [HR] = 0.652, 95% CI: 0.549-0.776) despite adjustment. Those with baseline Internet access were more likely to register (HR = 1.629, 95% CI: 1.294-2.050), and a significant educational gradient was also observed (more likely registration with higher educational levels). CONCLUSIONS: Differences in education, income, and Internet access did not account for the disparities in PHR registration by race. In the short-term, attempts to improve patient access to health care with PHRs may not ameliorate prevailing disparities between African Americans and whites.
    Source
    J Am Med Inform Assoc. 2009 Sep-Oct;16(5):683-9. Epub 2009 Jun 30. Link to article on publisher's site
    DOI
    10.1197/jamia.M3169
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/47821
    PubMed ID
    19567790
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1197/jamia.M3169
    Scopus Count
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    Population and Quantitative Health Sciences Publications

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