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Int J Med Inform. 2012 Oct;81(10):e39-45. doi: 10.1016/j.ijmedinf.2012.06.006. Epub 2012 Aug 11.
This paper presents research on the interplay of health information technology (HIT), quality improvement and progression of health status. The purpose of the research was to determine whether electronic exchange of health information impacts quality of care and, by extension, health outcomes of patients with HIV/AIDS. The research was supported as a demonstration project under the Information Technology Networks of Care Initiative sponsored by the U.S. Health Resources and Services Administration, HIV/AIDS Bureau, Special Projects of National Significance (SPNS). The City of Paterson, New Jersey, Department of Health and Human Services administered the project as the grant recipient, secured and managed through the City of Paterson's Ryan White Part A Program of Bergen and Passaic Counties.
We implemented a web-based health information support system, e2, to facilitate rigorous quality improvement activities associated with care and treatment of HIV/AIDS patients. We used e2 to monitor patient care in the clinic setting. We observed five quality and two health status indicators relating to the care of 263 HIV/AIDS medical patients at three HIV/AIDS medical clinics from 2008 to 2010. The quality indicators conformed to HIV/AIDS Bureau (HAB) Groups 1 and 2 definitions of two or more CD4 T-cell counts performed in the measurement year, AIDS patients prescribed HAART, two or more medical visits in the measurement year, PCP prophylaxis administered to AIDS patients with CD4 T-cell counts <200, and adults screened for syphilis within the measurement year. CD4 T-cell count and viral load suppression indicators were used as health status indicators. Frequency analysis and logistic generalized estimating equations were used to assess correlation. We also assessed user satisfaction with e2 as a quality improvement tool using qualitative methods.
Availability of the e2 system was a leading contributing factor in successful quality management activities, leading to improved quality of care and health status of HIV/AIDS patients across all three clinics. Significant improvements were observed in three of the five quality indicators and in both of the two health status indicators.
We conclude that health information technology as a tool for rigorous application of quality improvement methods can positively impact quality of care and health outcomes. We found that health outcomes improved over time when quality improvement methods were initiated and facilitated by a responsive electronic information support system.
本文研究了健康信息技术（HIT）、质量改进和健康状况进展之间的相互作用。研究目的是确定电子健康信息交换是否会影响护理质量，并进而影响艾滋病毒/艾滋病患者的健康结果。该研究是在美国卫生资源和服务管理局、艾滋病毒/艾滋病局、特别国家项目（SPNS）赞助的信息技术护理网络倡议下作为示范项目进行的。新泽西州帕特森市卫生和人类服务部作为赠款接受方管理该项目，通过帕特森市的伯根和帕塞伊克县的瑞安·怀特 A 部分计划获得并管理该项目。
我们实施了一个基于网络的健康信息支持系统 e2，以促进与艾滋病毒/艾滋病患者护理和治疗相关的严格质量改进活动。我们使用 e2 来监测诊所环境中的患者护理。我们观察了 2008 年至 2010 年期间来自三个艾滋病毒/艾滋病医疗诊所的 263 名艾滋病毒/艾滋病医疗患者的五个质量和两个健康状况指标。这些质量指标符合艾滋病毒/艾滋病局（HAB）第 1 组和第 2 组关于在测量年内进行两次或更多次 CD4 T 细胞计数、为接受抗逆转录病毒疗法的艾滋病患者开处方、在测量年内进行两次或更多次医疗就诊、为 CD4 T 细胞计数<200 的艾滋病患者提供肺炎球菌预防以及在测量年内对梅毒进行筛查的定义。CD4 T 细胞计数和病毒载量抑制指标被用作健康状况指标。我们还使用定性方法评估了用户对 e2 作为质量改进工具的满意度。
e2 系统的可用性是成功质量管理活动的主要促成因素，导致所有三个诊所的艾滋病毒/艾滋病患者的护理质量和健康状况得到改善。在五个质量指标中的三个和两个健康状况指标中的两个方面都观察到了显著的改善。
我们得出的结论是，健康信息技术作为严格应用质量改进方法的工具，可以对护理质量和健康结果产生积极影响。我们发现，当通过响应式电子信息支持系统启动和促进质量改进方法时，健康结果会随着时间的推移而改善。
