Alexandre Pierre K, Monestime Judith P, Alexandre Kessie
Health Administration Program, Department of Management, College of Business, Florida Atlantic University, Boca Raton, FL.
Department of Geography, University of Washington, Seattle, WA.
Med Care. 2024 Apr 1;62(4):256-262. doi: 10.1097/MLR.0000000000001980. Epub 2024 Feb 27.
Using federal funds from the 2009 Health Information Technology for Economic and Clinical Health Act, the Centers for Medicare and Medicaid Services funded the 2011-2021 Medicaid electronic health record (EHR) incentive programs throughout the country.
Identify the market factors associated with Meaningful Use (MU) of EHRs after primary care providers (PCPs) enrolled in the Florida-EHR incentives program through Adopting, Improving, or Upgrading (AIU) an EHR technology.
Retrospective cohort study using 2011-2018 program records for 8464 Medicaid providers.
MU achievement after first-year incentives.
The resource dependence theory and the information uncertainty perspective were used to generate key-independent variables, including the county's rurality, educational attainment, poverty, health maintenance organization penetration, and number of PCPs per capita.
All the county rates were converted into 3 dichotomous measures corresponding to high, medium, and low terciles. Descriptive and bivariate statistics were calculated. A generalized hierarchical linear model was used because MU data were clustered at the county level (level 2) and measured at the practice level (level 1).
Overall, 41.9% of Florida Medicaid providers achieved MU after receiving first-year incentives. Rurality was positively associated with MU ( P <0.001). Significant differences in MU achievements were obtained when we compared the "high" terciles with the "low" terciles for poverty rates ( P =0.002), health maintenance organization penetration rates ( P =0.02), and number of PCPs per capita ( P =0.01). These relationships were negative.
Policy makers and health care managers should not ignore the contribution of market factors in EHR adoption.
医疗保险和医疗补助服务中心利用2009年《经济和临床健康的健康信息技术法案》提供的联邦资金，在全国范围内资助了2011 - 2021年医疗补助电子健康记录（EHR）激励计划。
确定在初级保健提供者（PCP）通过采用、改进或升级（AIU）电子健康记录技术参加佛罗里达州电子健康记录激励计划后，与电子健康记录的有意义使用（MU）相关的市场因素。
采用回顾性队列研究，使用了8464名医疗补助提供者2011 - 2018年的项目记录。
第一年激励措施后的有意义使用达成情况。
资源依赖理论和信息不确定性观点被用于生成关键自变量，包括县的农村程度、教育程度、贫困程度、健康维护组织渗透率以及人均初级保健提供者数量。
所有县的比率被转换为对应高、中、低三分位数的3个二分变量。计算了描述性和双变量统计量。使用了广义分层线性模型，因为有意义使用数据在县一级（第2级）聚类，并在医疗机构一级（第1级）测量。
总体而言，41.9%的佛罗里达州医疗补助提供者在获得第一年激励后实现了有意义使用。农村程度与有意义使用呈正相关（P <0.001）。当我们将贫困率、健康维护组织渗透率和人均初级保健提供者数量的“高”三分位数与“低”三分位数进行比较时，有意义使用达成情况存在显著差异（贫困率P =0.002，健康维护组织渗透率P =0.02，人均初级保健提供者数量P =0.01）。这些关系为负相关。
政策制定者和医疗保健管理者不应忽视市场因素在电子健康记录采用中的作用。
