Health Policy & Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA 30460, USA.
J Public Health Manag Pract. 2012 Mar-Apr;18(2):160-8. doi: 10.1097/PHH.0b013e318226c9ef.
The purpose of this article is to explore the relationship between local health departments' (LHDs') governance structures and their use of information systems (IS) and information technologies (IT). As the US health system moves toward more integrated models of delivering care, LHDs have been identified as key nexus for information exchange. Therefore, understanding how LHDs' governance facilitates or inhibits the adoption and use of such IS and IT tools is critical.
The 2008 survey of the National Association of County and City Health Officials' members included a set of questions dedicated to the use of IS/IT and its relationship to governance structures. Ordinal logistic and Poisson regressions are used to identify significant relationships among the variables. The survey sample's results (n = 473) are extended to the national sample (N = 2794) using the variable weightings included in the study design.
The 2 dependent variables examined are IS and IT use. The IS variable captures the software and analytic tools used in LHDs. The IT measure primarily captures hardware and infrastructure capabilities.
Overall, the use of IS/IT by LHDs is low. Generally, LHDs that have shared governance structures with other state and community bodies tended to have greater IS/IT use. Similarly, larger LHDs with leaders that have higher educational levels used IS/IT in greater amounts.
With their current IS/IT capability levels, LHDs will struggle to play a meaningful role in the integration and exchange of health information. Given that LHD also serve at-risk populations in disproportionate numbers, this digital divide may become a real divide in the access to high quality care for some communities.
本文旨在探讨地方卫生部门（LHD）的治理结构与其信息系统（IS）和信息技术（IT）的使用之间的关系。随着美国医疗体系向提供医疗服务的更整合模式发展，LHD 已被确定为信息交换的关键枢纽。因此，了解 LHD 的治理结构如何促进或阻碍此类 IS 和 IT 工具的采用和使用至关重要。
2008 年对全国县和市卫生官员协会成员的调查包括一组专门针对 IS/IT 使用及其与治理结构关系的问题。采用有序逻辑回归和泊松回归来确定变量之间的显著关系。使用研究设计中包含的变量权重，将调查样本的结果（n=473）扩展到全国样本（N=2794）。
研究考察的两个因变量分别是 IS 和 IT 使用。IS 变量捕捉 LHD 中使用的软件和分析工具。IT 衡量标准主要捕捉硬件和基础设施能力。
总体而言，LHD 对 IS/IT 的使用程度较低。通常，与其他州和社区机构共享治理结构的 LHD 更倾向于使用 IS/IT。同样，领导者具有更高教育水平且规模更大的 LHD 使用 IS/IT 的数量也更多。
以当前的 IS/IT 能力水平，LHD 将难以在健康信息的整合和交换中发挥有意义的作用。鉴于 LHD 还为数以百万计的弱势群体提供服务，这种数字鸿沟可能会成为一些社区获得高质量医疗服务的真正鸿沟。
