Group Health Research Institute, Group Health Cooperative, Seattle, WA 98101, USA.
Am J Manag Care. 2013 Apr 1;19(4):e114-24.
To compare use of 7 shared electronic medical record (SMR) features by adult HIV patients.
Observational cohort study of adult HIV-positive patients in the first 36 months following implementation of the SMR at Group Health and Kaiser Permanente Northern California.
Automated data from the 36 months following SMR implementation were assessed in 2 integrated delivery systems. Cox proportional hazards analysis identified factors associated with any SMR use.
Most (3888/7398) patients used the SMR at least once. Users were most likely to view medical test results (49%), use secure messaging (43%), or request appointments (31%) or medication refills (30%). Initial use was associated with new prescription for antiretroviral therapy (rate ratio [RR] 1.65, P <.001), recent change to a CD4+ count of fewer than 200 cells per microliter (RR = 1.34, P <.02), new HIV RNA of 75 or more copies per milliliter (RR = 1.63, P <.001), or recent increase in non-HIV comorbidity score (RR = 1.49, P = .0001). Users were less likely to be women (RR = 0.49, P = .0001), injection drug users (RR = 0.59, P = .0001), or from lower-socioeconomic status neighborhoods (RR = 0.68, P = .0001), and were less likely to be black (RR = 0.38, P = .0001), Hispanic (RR = 0.52, P = .0001) or Asian/Pacific Islander (RR = 0.59, P = .001).
SMR use was higher among HIV patients who had indicators of recent increases in healthcare needs and lower among several vulnerable populations.
比较实施电子病历共享系统（SMR）后 36 个月内，HIV 成年患者对 7 个共享电子病历功能的使用情况。
这是一项在实施 SMR 后 36 个月内在 Group Health 和 Kaiser Permanente Northern California 的 HIV 阳性成年患者中进行的观察性队列研究。
从两个综合交付系统中评估了实施 SMR 后 36 个月的自动数据。Cox 比例风险分析确定了与任何 SMR 使用相关的因素。
大多数（3888/7398）患者至少使用过一次 SMR。用户最有可能查看医疗检查结果（49%）、使用安全消息（43%）、预约（31%）或药物续方（30%）。首次使用与新的抗逆转录病毒治疗处方（比率比[RR] 1.65，P<.001）、CD4+计数每微升少于 200 个细胞（RR=1.34，P<.02）、HIV RNA 达到 75 个或更多拷贝/毫升（RR=1.63，P<.001）或非 HIV 合并症评分最近增加（RR=1.49，P=.0001）有关。女性（RR=0.49，P=.0001）、注射吸毒者（RR=0.59，P=.0001）或来自社会经济地位较低的社区（RR=0.68，P=.0001）的患者使用 SMR 的可能性较小，黑人（RR=0.38，P=.0001）、西班牙裔（RR=0.52，P=.0001）或亚裔/太平洋岛民（RR=0.59，P=.001）的患者使用 SMR 的可能性也较小。
SMR 使用在最近医疗需求增加的 HIV 患者中更高，而在几个弱势群体中则较低。
