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J Am Med Inform Assoc. 2009 Sep-Oct;16(5):683-9. doi: 10.1197/jamia.M3169. Epub 2009 Jun 30.

Disparities in use of a personal health record in a managed care organization.

Author information

  • 1Center for Health Research/Southeast, Kaiser Permanente Georgia, Atlanta, GA, USA.

Abstract

OBJECTIVE:

Personal health records (PHRs) can increase patient access to health care information. However, use of PHRs may be unequal by race/ethnicity.

DESIGN:

The authors conducted a 2-year cohort study (2005-2007) assessing differences in rates of registration with KP.org, a component of the Kaiser Permanente electronic health record (EHR).

MEASUREMENTS:

At baseline, 1,777 25-59 year old Kaiser Permanente Georgia enrollees, who had not registered with KP.org, responded to a mixed mode (written or Internet) survey. Baseline, EHR, and KP.org data were linked. Time to KP.org registration by race from 10/1/05 (with censoring for disenrollment from Kaiser Permanente) was adjusted for baseline education, comorbidity, patient activation, and completion of the baseline survey online vs. by paper using Cox proportional hazards.

RESULTS:

Of 1,777, 34.7% (616) registered with KP.org between Oct 2005 and Nov 2007. Median time to registering a KP.org account was 409 days. Among African Americans, 30.1% registered, compared with 41.7% of whites (p < 0.01). In the hazards model, African Americans were again less likely to register than whites (hazard ratio [HR] = 0.652, 95% CI: 0.549-0.776) despite adjustment. Those with baseline Internet access were more likely to register (HR = 1.629, 95% CI: 1.294-2.050), and a significant educational gradient was also observed (more likely registration with higher educational levels).

CONCLUSIONS:

Differences in education, income, and Internet access did not account for the disparities in PHR registration by race. In the short-term, attempts to improve patient access to health care with PHRs may not ameliorate prevailing disparities between African Americans and whites.

PMID:
19567790
[PubMed - indexed for MEDLINE]
PMCID:
PMC2744719
Free PMC Article

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