Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, USA.
Health Care Manage Rev. 2012 Jan-Mar;37(1):14-22. doi: 10.1097/HMR.0b013e3182352562.
Previous studies identified individual or practice factors that influence practice-based physicians' electronic medical record (EMR) adoption. Less is known about the market factors that influence physicians' EMR adoption.
The aim of this study was to explore the relationship between environmental market characteristics and physicians' EMR adoption.
The Health Tracking Physician Survey 2008 and Area Resource File (2008) were combined and analyzed. Binary logistic regression was used to examine the relationship between three dimensions of the market environment (munificence, dynamism, and complexity) and EMR adoption controlling for several physician and practice characteristics.
In a nationally representative sample of 4,720 physicians, measures of market dynamism including increases in unemployment, odds ratio (OR) = 0.95, 95% confidence interval (CI) [0.91, 0.99], or poverty rates, OR = 0.93, 95% CI [0.89, 0.96], were negatively associated with EMR adoption. Health maintenance organization penetration, OR = 3.01, 95% CI [1.49, 6.05], another measure of dynamism, was positively associated with EMR adoption. Physicians practicing in areas with a malpractice crisis, OR = 0.82, 95% CI [0.71, 0.94], representing environmental complexity, had lower EMR adoption rates.
Understanding how market factors relate to practice-based physicians' EMR adoption can assist policymakers to better target limited resources as they work to realize the national goal of universal EMR adoption and meaningful use.
先前的研究确定了影响实践型医生采用电子病历（EMR）的个体或实践因素。但对于影响医生采用 EMR 的市场因素知之甚少。
本研究旨在探讨环境市场特征与医生采用 EMR 之间的关系。
将 2008 年《健康追踪医生调查》和《区域资源文件》（2008 年）合并并进行分析。使用二元逻辑回归，控制医生和实践特征的几种因素，检验市场环境的三个维度（丰富性、动态性和复杂性）与 EMR 采用之间的关系。
在全国代表性的 4720 名医生样本中，市场动态性的衡量标准，包括失业率上升（OR=0.95，95%置信区间[0.91，0.99]）或贫困率（OR=0.93，95%置信区间[0.89，0.96]），与 EMR 采用呈负相关。健康维护组织的渗透率（OR=3.01，95%置信区间[1.49，6.05]），也是动态性的另一个衡量标准，与 EMR 采用呈正相关。在面临医疗事故危机的地区行医的医生（OR=0.82，95%置信区间[0.71，0.94]），代表环境复杂性，其 EMR 采用率较低。
了解市场因素与实践型医生 EMR 采用之间的关系，可以帮助政策制定者更好地利用有限资源，实现全民 EMR 采用和有意义使用的国家目标。
