Building Communities Through Technology (California Community Technology Foundation)
One of the AHRQ-relevant specific aims was to assess the readiness of
both patients and community health center staff to use
health-information technologies through focus groups and individual
interviews.
Principal Investigator: Richard S. Baker, MD (
Rbaker2@ucla.edu)
The specific aims of this proposal are to: (1) assess ways in which
consumer and healthcare technologies can be used to reduce health
disparities and enhance access to care for poor and uninsured persons
residing in south Los Angeles, (2) assess the readiness of both
patients and community health center staff to implement health
information technologies (HIT) in six health domains; (3) establish an
infrastructure that supports community participation in the research
process; and (4) broadly disseminate findings of this study to clinical
and public health providers, other researchers, policy makers, and the
general community about the use of information technology to close the
digital health divide. To accomplish the first and second aims, surveys
of both clinic staff and patients seen at the Wilmington Community
Clinic (WCC) and Mary Henry Telemedicine Clinic (MHTC) will be
undertaken to identify the knowledge, attitudes, skills and
availability of resources relative to health information technology.
The two surveys will utilize both qualitative and quantitative methods
and result in an overall assessment of the knowledge, attitudes, and
skills of patients and clinic staff across six health domains: primary
care, health promotion, specialty care, public health, continuing
education, and health care financing and administration. The surveys
also will assess the availability of resources in the clinics, homes
and communities for using HIT to increase access to care and decrease
health disparities. To carry out the third aim, community-based
participatory research processes and structures involving academic
researchers and community representatives will be established so as to
employ local knowledge in the understanding of health problems and the
design of interventions. Community members and clinic staff will be
engaged across the continuum of research processes and products from
development to dissemination. Patients and staff will be equal partners
with academic researchers in developing questionnaires, community
recruitment and training, analysis of results, and dissemination
activities. The fourth aim will be accomplished by submitting a minimum
of three publications, hosting one community-wide forum by the end of
the first year, submitting two research proposals for additional
funding to sustain and further research activities initiated through
this announcement, and hosting a HIT Policy Summit at the end of the
second year.
Proposed Project, Scope of Work, Experience, Methodologies and Timeline
The
demand for adapting new information technologies by the healthcare
system is being driven by a number of factors including the dynamic
restructuring of the health care delivery system, increasing provider
demand for comprehensive real-time information to manage complex
chronic diseases, and growing interest among patients to participate
more fully in their own care through self-management activities. These
emerging trends offer considerable promise for expanding access to more
efficient, cost effective, and better overall quality of care, reducing
redundancy and duplication of efforts, enhancing coordination of
patient management activities among primary, specialty, hospital, home
health, ancillary and other community care providers, improving patient
safety, and realizing better overall health outcomes.
While information technologies portend great opportunities for
improving the health status of the population in general, the digital
health divide largely prevents people in poor and medically underserved
communities from being able to benefit from these technological
advances. Without changes in public policy, the digital health divide
is likely to result in increasing disparities in health status among
residents of low income urban and rural areas. The pursuit of public
policies that promote and support access to broadband internet and
related information technologies to decrease health disparities by
disenfranchised people are greatly needed. Two research questions will
be addressed by this study: 1. What access to health information
technologies is available to staff, patients, and communities in south
central Los Angeles, and 2. What are the attitudes, knowledge, and
skills that staff and patients have towards health information
technologies and how might they affect its implementation in increasing
access to care and reducing health disparities.
Methodology
This proposal seeks to assess the extent
of the digital health divide in an urban medically underserved
community by examining the readiness of both health care providers and
consumers to use health information technologies to increase access to
care and decrease disparities and to identify the availability of
resources in the clinic, homes, and community to deploy them. To
accomplish this, two surveys will be conducted: one of community clinic
staff and the other of patients seen at the community clinics. The
surveys will utilize both qualitative and quantitative methods and
result in an overall assessment of the readiness, (defined as
knowledge, attitudes, and skills) and resources available to staff
and/or patients across six health domains in which information
technologies have been identified as having the potential to increase
access to care and decrease health disparities. Questions in each of
these domains will address knowledge, attitudes, skills, and
availability of resources that are needed to implement and support the
identified information technologies.
Four of the six health domains and related technologies are
common to both providers and consumers while two are specific to
providers. The four common domains and associated technologies that
will be addressed in the surveys of both providers and consumers are:
primary care (electronic medical records), specialty care
(telemedicine, tele-ophthalmology, disease management), and health
promotion (tele-home care and remote patient monitoring,
video-conferencing). The remaining domains and related technologies
that will be included in the provider surveys include public health
(geographic information systems (GIS)), continuing education (distance
learning) and health care financing and data management (practice
management, database management, report generation, and research).
The digital health divide is impacted but not limited to whether or not
providers and consumers have a computer or internet access in their
home. Rather, other factors such as language, typing skills, attitudes
and knowledge towards the use of computers and technology, hardware and
software compatibility, and type of internet access are all related and
may affect the feasibility of the use of information technology in the
delivery and consumption of health care services. Just as the
underlying causes of the digital health divide are complex, strategies
for overcoming this divide, must be multi-faceted, flexible, and
redundant to meet a range of different individual, family, and
community circumstances.
