Health Information Technology in Ambulatory Care Settings: Effects on Quality and Disparities (California)

Project Final Report (PDF, 106.85 KB) Disclaimer

Summary:

There is currently a research gap on the effects of health information technology (IT) on healthcare quality and disparities in the ambulatory care setting. Previous research has focused on the inpatient hospital setting, though most healthcare services are provided in the ambulatory setting, overlooking an area of large potential cost savings from hospitalization preventions.

The goal of this project was to use existing data to study the effects of electronic medical records (EMRs), picture archiving, and practice management systems on healthcare quality and racial disparities in the ambulatory care setting. The results may inform policymaking in the area of health IT, where Federal resources are being devoted to promoting adoption to reduce costs and improve quality.

The specific aims of the project were as follows:

  • Develop a national panel database that measures the degree of ambulatory health IT in local areas. 
  • Combine the data on ambulatory IT with local-area panel measures of ambulatory care quality and controls for population and healthcare factors. 
  • Estimate the effects of health IT on the quality of ambulatory care. 
  • Estimate differential effects of health IT on different racial and ethnic sub-populations. 

Researchers constructed measures of county-level ambulatory care quality and county-level health IT adoption using data from Medicare, the Nationwide Inpatient Sample, and the Healthcare Information and Management Systems Society (HIMSS) Analytics Database. The study team explored associations between the IT measures and ambulatory care quality as measured by local rates of hospitalizations, and also analyzed gender, age, racial, and ethnic disparities.

Study outcomes indicated that greater adoption of county-level ambulatory health IT, including EMRs, picture archiving, and practice management, significantly lowered rates of Medicare hospitalizations of conditions that may be prevented by vaccines or effective healthcare management, suggesting improved quality of care. Outcomes also indicated that the largest gains from ambulatory IT adoption, in the form of fewer hospital admissions, were for patients over the age of 65. Younger patients also had a lower admission rate with greater health IT adoption, though the results were not statistically significant. Finally, the study did not find any consistent differential effects of ambulatory IT with regard to sex, race, or ethnicity demographic groups. The measures and models developed in this study may be applied by other researchers for future large-scale evaluations of IT implementation in ambulatory settings.

Health Information Technology in Ambulatory Care Settings: Effects on Quality and Disparities - 2012

Summary Highlights

  • Principal Investigator: 
  • Organization: 
  • Funding Mechanism: 
    PAR: HS08-269: Exploratory and Developmental Grant to Improve Health Care Quality Through Health Information Technology (IT) (R21)
  • Grant Number: 
    R21 HS 021301
  • Project Period: 
    September 2012 – September 2014
  • AHRQ Funding Amount: 
    $290,456
  • PDF Version: 
    (PDF, 247.42 KB)

Summary: Considerable resources are being devoted to promoting the diffusion of information technology (IT) in health care. However, there is limited empirical evidence about the effects of health IT on health care quality and potential differences in impact across racial and ethnic groups. Ambulatory settings, where the majority of health care is provided, are a current target of Federal policies incentivizing health IT adoption. Yet evidence of health IT’s impact on ambulatory settings is scarce.

This project will develop and implement a large-scale, multi-state, multi-year approach to measuring the impact of health IT on the quality and variability of care in ambulatory settings. The project team is developing a set of time-varying measures of local area health IT adoption that includes ambulatory care providers, hospitals, and health systems. The project explores associations between the developed health IT measures and ambulatory care quality. These comparisons will include an analysis of racial and ethnic disparities. The primary data source will be the Healthcare Information and Management Systems Society (HIMSS) AnalyticsTM Database.

Specific Aims:

  • Develop longitudinal measures of local area health IT that have the potential to affect ambulatory care quality. (Ongoing)
  • Estimate the effects of health IT on the quality of ambulatory care. (Upcoming)
  • Estimate the effects of health IT on racial and ethnic disparities in ambulatory care quality. (Upcoming)

2012 Activities: Dr. Miller has assembled a project team and hired a research assistant to conduct the programming tasks. The project experienced some administrative delays in the first quarter, but Dr. Miller anticipates that the project will regain the original timeline in early 2013. As last self-reported in the AHRQ Research Reporting System, project progress and activities are mostly on track, though project budget funds are significantly underspent due to the delay.

Preliminary Impact and Findings: This project has no findings to date.

Target Population: Racial or Ethnic Minorities*: African American, Hispanic

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care.

Business Goal: Knowledge Creation

*This target population is one of AHRQ’s priority populations.

Health Information Technology in Ambulatory Care Settings: Effects on Quality and Disparities - Final Report

Citation:
Miller A. Health Information Technology in Ambulatory Care Settings: Effects on Quality and Disparities - Final Report. (Prepared by RAND Corporation under Grant No. R21 HS021301). Rockville, MD: Agency for Healthcare Research and Quality, 2015. (PDF, 106.85 KB)

The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. 
Principal Investigator: 
Document Type: 
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