Disparities in use of a personal health record in a managed care organization
Department of Quantitative Health Sciences
Medical Subject Headings
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
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.
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Citation: J Am Med Inform Assoc. 2009 Sep-Oct;16(5):683-9. Epub 2009 Jun 30. Link to article on publisher's site