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The American Journal of Managed Care August 2016
Variation in US Outpatient Antibiotic Prescribing Quality Measures According to Health Plan and Geography
Rebecca M. Roberts, MS; Lauri A. Hicks, DO; and Monina Bartoces, PhD
Aligning Payment Reform and Delivery Innovation in Emergency Care
Jesse M. Pines, MD, MBA; Frank McStay, MPA; Meaghan George, MPP; Jennifer L. Wiler, MD, MBA; and Mark McClellan, MD, PhD
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Li-Hao Chu, PhD; Michael Tu, MS; Yuan-Chi Lee, MS; Jennifer N. Sayles, MD; and Neeraj Sood, PhD
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James D. Chambers, PhD; Pallavi B. Rane, PhD; and Peter J. Neumann, ScD
Currently Reading
Socioeconomic Disparities in Adoption of Personal Health Records Over Time
Jessica S. Ancker, PhD, MPH; Baria Hafeez, MS; and Rainu Kaushal, MD, MPH
The Financial Impact of Team-Based Care on Primary Care
Thomas E. Kottke, MD, MSPH; Michael V. Maciosek, PhD; Jacquelyn A. Huebsch, RN, PhD; Paul McGinnis, MD; Jolleen M. Nichols, RN; Emily D. Parker, PhD; and Juliana O. Tillema, MPA
Opinions on the Hospital Readmission Reduction Program: Results of a National Survey of Hospital Leaders
Karen E. Joynt, MD, MPH; Jose F. Figueroa, MD, MPH; E. John Orav, PhD; and Ashish K. Jha, MD, MPH
Choosing Wisely: Spine Imaging
Robert Ferrari, MD, MSc (Med), FRCPC, FACP, and Risha Gidwani, DrPH
Association Among Change in Medical Costs, Level of Comorbidity, and Change in Adherence Behavior
Steven M. Kymes, PhD; Richard L. Pierce, PhD; Charmaine Girdish, MPH; Olga S. Matlin, PhD; Troyen Brennan, MD, JD, MPH; and William H. Shrank, MD, MSHS

Socioeconomic Disparities in Adoption of Personal Health Records Over Time

Jessica S. Ancker, PhD, MPH; Baria Hafeez, MS; and Rainu Kaushal, MD, MPH
Over 4 years, rates of personal health record use increased rapidly across the board, but a digital divide remained evident.

Objectives: Since 2009, federal policies have incentivized medical organizations to provide medical record access to patients. We sought to track personal health record (PHR) adoption and differences by sociodemographic group over time.

Study Design: Random-digit-dial survey conducted for 4 consecutive years in New York state.

Methods: The Empire State Poll is a random digit-dial survey conducted every year in New York state, with an annual sample size of 800 individuals, weighted to create a representative state sample. We analyzed 4 consecutive years of poll data to examine trends.

Results: The proportion of New Yorkers using PHRs rose sharply, from 11% in 2012 to 27% in 2015. By 2015, there were no significant differences in PHR use between blacks and other races, but Hispanics and low-income respondents were less likely to use PHRs.

Conclusions: During a 4-year period in which federal policies incentivized medical organizations to give medical record access to patients through PHRs and electronic portals, rates of PHR use increased rapidly in all sociodemographic groups. However, a digital divide remains evident, linked to Hispanic ethnicity and lower income.
Am J Manag Care. 2016;22(8):539-540
Take-Away Points
  • More patients are using personal health records (PHRs) than ever before.
  • Current data suggest blacks and other races are equally likely to use PHRs; however, Hispanics and patients with Medicaid are still less likely to use PHRs.
  • Additional outreach may still be necessary to ensure disadvantaged groups are using available technologies.
Giving patients access to their medical data through personal health records (PHRs) and electronic patient portals has been promoted as a way to engage them in healthcare decisions and health promotion.1,2 An electronic patient portal is a Web-based account provided by a healthcare organization that allows patients to view their medical records, correspond securely with healthcare providers, and perform other health-related tasks, such as requesting medication refills. Portals are sometimes called “tethered PHRs” because of their close link to a single healthcare organization. Portals have become more common in the United States3 as a result of the Federal Electronic Health Record (EHR) Incentive Program (informally known as the “Meaningful Use” program).
Since 2010, this program has been incentivizing healthcare providers and hospitals to adopt EHRs, and when they do, they are required to make the electronic data available to patients.4 However, early studies of these consumer types of information technology (IT) showed that patients in disadvantaged socioeconomic groups were less likely to use them, leading to concern that the “digital divide” might prevent some of the neediest patients from benefiting.5-8 Additionally, patients with less education may also have less confidence in the benefits of health IT.9 To investigate the rate of public adoption of health IT over time, we asked about portal/PHR use in random-digit-dial telephone polls for 4 consecutive years in the state of New York.
The Empire State Poll is a survey of adult New York state residents (n = 800) conducted by the Survey Research Institute of Cornell University.10 Each year, samples are drawn from random-digit-dial lists covering cell and land lines. Response rates (the number of completed surveys divided by total eligible sample) have been 22% to 33% each year, with cooperation rates (the number of completed surveys divided by eligible individuals contacted) between 66% and 70%.
Since 2011, we have included questions to assess public attitudes and perceptions of health IT.11 From 2012 through 2015, we included the following question: “Some hospitals, doctor’s offices, health plans, and different organizations are offering websites where you can get, keep, and update your health information online. This information could be lab test results, medicines, doctor visits, or other information. You would get a user name and password so that only you could see your information on this website. These websites are sometimes called personal health records (PHRs) or patient portals. Have you ever used one of these websites where you can get, keep, or update your health information?”
Chi-squared tests and Cochrane-Armitage tests for trend were performed using survey weights to account for the sampling design and produce statewide estimates. The study was approved by the Cornell University Institutional Review Board.

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