Interoperability among hospitals treating populations that have been marginalized.

OBJECTIVE: To test whether differences in hospital interoperability are related to the extent to which hospitals treat groups that have been economically and socially marginalized. DATA SOURCES AND STUDY SETTING: Data on 2393 non-federal acute care hospitals in the United States from the American Hospital Association Information Technology Supplement fielded in 2021, the 2019 Medicare Cost Report, and the 2019 Social Deprivation Index. STUDY DESIGN: Cross-sectional analysis. DATA COLLECTION/EXTRACTION METHODS: We identified five proxy measures related to marginalization and assessed the relationship between those measures and the likelihood that hospitals engaged in all four domains of interoperable information exchange and participated in national interoperability networks in cross-sectional analysis. PRINCIPAL FINDINGS: In unadjusted analysis, hospitals that treated patients from zip codes with high social deprivation were 33% less likely to engage in interoperable exchange (Relative Risk = 0.67, 95% CI: 0.58-0.76) and 24% less likely to participate in a national network than all other hospitals (RR = 0.76; 95% CI: 0.66-0.87). Critical Access Hospitals (CAH) were 24 percent less likely to engage in interoperable exchange (RR = 0.76; 95% CI: 0.69-0.83) but not less likely to participate in a national network (RR = 0.97; 95% CI: 0.88-1.06). No difference was detected for 2 measures (high Disproportionate Share Hospital percentage and Medicaid case mix) while 1 was associated with a greater likelihood to engage (high uncompensated care burden). The association between social deprivation and interoperable exchange persisted in an analysis examining metropolitan and rural areas separately and in adjusted analyses accounting for hospital characteristics. CONCLUSIONS: Hospitals that treat patients from areas with high social deprivation were less likely to engage in interoperable exchange than other hospitals, but other measures were not associated with lower interoperability. The use of area deprivation data may be important to monitor and address hospital clinical data interoperability disparities to avoid related health care disparities.

Disparities in patient portal access and the role of providers in encouraging access and use.

OBJECTIVE: The aim of this study was to identify racial and ethnic disparities in patient portal offers, access, and use and to examine the role of providers in facilitating access to electronic health information (EHI) by offering patient portals and encouraging their use. MATERIALS AND METHODS: Using nationally representative survey data from 2019 and 2020 (N = 8028), we examined disparities in patients being offered access to a portal by their provider and differences in subsequent access and use. Using multivariable models, we estimated the effect of race and ethnicity on the likelihood of being offered, accessing or using a portal. Among those offered, we examined the relationship between provider encouragement and portal access; and for those who did not access their portal, we explored reasons for nonuse. RESULTS: Black and Hispanic individuals were offered and accessed patient portals at significantly lower rates than White individuals. Compared to Whites, Black and Hispanic individuals were 5.2 percentage-points less likely to be offered a portal (P < .05) and, among those offered, 7.9 percentage-points less likely to access their portal (P < .05). Black and Hispanic individuals who were offered and accessed a portal were 12 percentage-points more likely than Whites to use it to download or transmit information (P < .01). Individuals who were offered a portal and encouraged to use it were 21 percentage-points more likely to access it. DISCUSSION: Differences in patient portal access and use are likely driven by disparities in which groups of patients reported being offered a portal. CONCLUSIONS: Providers play an important role in increasing access to EHI by facilitating access to patient portals.

Barriers to accessing online medical records in the United States.

OBJECTIVES: Patients' access to and use of online medical records (OMRs) can facilitate better management of their health and health care. However, health care disparities continue to exist. This study aimed to (1) determine the prevalence and predictors of individuals being offered access to OMRs, (2) identify predictors of individuals accessing their OMR, and (3) describe barriers to accessing one's OMR. STUDY DESIGN: Secondary analyses of cross-sectional data from Health Information National Trends Survey 5, cycles 1 and 2 (n = 6670). METHODS: Multivariable logistic regression analyses were used to examine the association between sociodemographic and health care-related factors on being offered access to OMRs, accessing OMRs, and cited reasons for not accessing OMRs. RESULTS: In 2017-2018, 54% of US adults reported having been offered access to OMRs, and among those offered, 57% reported accessing their records. The groups who were less likely to be offered OMRs included men, middle-aged adults, members of racial/ethnic minority groups, individuals with lower education and household incomes, those who do not use the internet, and those living in rural areas. Respondents who were less likely to access their OMRs despite being offered included individuals with lower education and household incomes and rural residents. Among the 43% who did not access their records, the primary reason for not accessing was their preference to speak to their provider directly. CONCLUSIONS: Sociodemographic and health care-related factors are associated with variation in use of OMRs. To realize the intended value of OMR use for patients, it is important to address barriers to OMR access and integrate OMRs into patient-provider communication and clinical care.

Addressing Rural Geographic Disparities Through Health IT: Initial Findings From the Health Information National Trends Survey.

BACKGROUND: Rural communities experience disparate rates of chronic diseases and face distinct challenges in gaining access to health care. Increasing the reach of the US health information and communication technology infrastructure can support rural health by overcoming geographic and temporal health care barriers. OBJECTIVES: The goal of the study is to establish statistically valid point estimates for the use of health information technology within rural versus urban populations, and to understand the degree to which structural factors may account for the overall variance in the use of these technologies. METHODS: Data from the National Cancer Institute's 2017 Health Information National Trends Survey were used to estimate prevalence of Health IT engagement across rural and urban populations and model factors influencing use of online medical records. RESULTS: Rural residents reported similar rates of providers maintaining electronic health records and offering access to online medical records. However, rural residents with provider-maintained records were less likely to receive a provider recommendation to use online medical records and were subsequently less likely to actually access records. Observed differences in online medical record use were accounted for by variance in Internet access, access to a regular health care provider, and whether providers encouraged patients to use online records. CONCLUSIONS: Findings shed light on structural opportunities for overcoming geographic and temporal barriers to Health IT and extending the benefits of digital health information technologies to underserved populations.

Progress In Interoperability: Measuring US Hospitals' Engagement In Sharing Patient Data.

Achieving an interoperable health care system remains a top US policy priority. Despite substantial efforts to encourage interoperability, the first set of national data in 2014 suggested that hospitals' engagement levels were low. With 2015 data now available, we examined the first national trends in engagement in four domains of interoperability: finding, sending, receiving, and integrating electronic patient information from outside providers. We found small gains, with 29.7 percent of hospitals engaging in all four domains in 2015 compared to 24.5 percent in 2014. The two domains with the most progress were sending (with an increase of 8.1 percentage points) and receiving (an increase of 8.4 percentage points) information, while there was no change in integrating systems. Hospitals' use for patient care of data from outside providers was low, with only 18.7 percent of hospitals reporting that they "often" used these data. Our results reveal that hospitals' progress toward interoperability is slow and that progress is focused on moving information between hospitals, not on ensuring usability of information in clinical decisions.

National findings regarding health IT use and participation in health care delivery reform programs among office-based physicians.

OBJECTIVE: Our objective was to characterize physicians' participation in delivery and payment reform programs over time and describe how participants in these programs were using health information technology (IT) to coordinate care, engage patients, manage patient populations, and improve quality. MATERIALS AND METHODS: A nationally representative cohort of physicians was surveyed in 2012 (unweighted N = 2567) and 2013 (unweighted N = 2399). Regression analyses used those survey responses to identify associations between health IT use and participation in and attrition from patient-centered medical homes (PCMHs), accountable care organizations (ACOs), and pay-for-performance programs (P4Ps). RESULTS: In 2013, 45% of physicians participated in PCMHs, ACOs, or P4Ps. While participation in each program increased (P < .05) between 2012 and 2013, program attrition ranged from 31-40%. Health IT use was associated with greater program participation (RR = 1.07-1.16). PCMH, ACO, and P4P participants were more likely than nonparticipants to perform quality improvement and patient engagement activities electronically (RR = 1.09-1.14); only ACO participants were more likely to share information electronically (RR = 1.07-1.09). DISCUSSION: Participation in delivery and payment reform programs increased between 2012 and 2013. Participating physicians were more likely to use health IT. There was significant attrition from and switching between PCMHs, ACOs, and P4Ps. CONCLUSION: This work provides the basis for understanding physician participation in and attrition from delivery and payment reform programs, as well as how health IT was used to support those programs. Understanding health IT use by program participants may help to identify factors enabling a smooth transition to alternative payment models.

US hospital engagement in core domains of interoperability.

OBJECTIVES: To assess US hospital engagement in the 4 core domains of interoperability (find, send, receive, integrate) and whether engaging in these domains is associated with electronic availability of clinical data from outside providers. STUDY DESIGN: Retrospective analysis of survey data. METHODS: Analysis of the American Hospital Association (AHA) Annual Survey of Hospitals and the American Hospital Association (AHA) Annual Survey of Hospitals - IT Supplement datasets for 2014. Respondents included 3307 US hospitals to the AHA Annual Survey - IT Supplement. We created measures of hospital engagement in 4 core domains of interoperability, as well as access to electronic clinical data from outside providers. Regression analysis was to identify hospital characteristics associated with each measure. RESULTS: Twenty-one percent of US hospitals engaged in all 4 interoperability domains, and 25% engaged in none. Hospitals engaged in all 4 domains were more likely to have a "basic" (odds ratio [OR], 3.53; P < .01) or "comprehensive" (OR, 5.04; P < .01) electronic health record (EHR) in comparison to a less than "basic" EHR, participate in a Regional Health Information Organization (OR, 4.29; P < .01), use a single EHR vendor (OR, 2.15; P < .01), and have a third-party health information exchange vendor (OR, 2.32; P < .01). They also differed by non-IT characteristics, such as medical home participation (OR, 1.77; P < .01). Hospitals that find (OR, 5.51; P < .01), receive (OR, 2.56; P < .01), or integrate (OR, 2.53; P < .01) information were more likely to report routine clinical information availability from outside providers. CONCLUSIONS: The one-fifth of US hospitals engaged in key domains of interoperability were more likely to have certain information technology infrastructure and participate in delivery reform. Encouragingly, interoperability engagement was associated with routine clinical information availability. Our results point to the need for ongoing efforts to expand interoperability, with the potential benefit of better information availability for clinicians and better care.

Predictors of Nonadherence to Topical Intraocular Pressure Reduction Medications Among Medicare Members: A Claims-Based Retrospective Cohort Study.

BACKGROUND: Reported adherence rates with ocular hypotensive medications typically range from 51% to 56% over the first year of therapy. As intraocular pressure (IOP) reduction slows the progression of vision loss from glaucoma, early identification of nonadherent members is crucial to effective disease management. OBJECTIVES: To (a) identify member characteristics and other factors related to nonadherence with topical IOP-lowering medications available in administrative claims data and (b) create a predictive model incorporating these variables. METHODS: This retrospective cohort study analyzed data from Humana's administrative claims database. The study cohort included members aged 65-89 years enrolled in a Medicare Advantage Prescription Drug plan (MAPD; medical and pharmacy benefits), with > 1 topical IOP-lowering medication claims between January 2011 and September 2012 and a minimum of 24 months of continuous enrollment-12 months before and 12 months after the initial (index) prescription claim for a topical IOP-lowering medication. Adherence was defined as the proportion of days covered (PDC) with drug supply (calculated from the number of drops per bottle and dose) over the first year after the index prescription. Members with PDC > 0.80 were considered adherent, while members with PDC < 0.80 were considered nonadherent. Multivariable stepwise logistic regression with backward elimination was used to construct a predictive model for the likelihood of nonadherence (PDC < 0.80). The model was developed using 28 input variables*#x2013;10 variables were retained in the final model. RESULTS: 73,256 MAPD members were included in this study; most (69%) of these members were continuing topical IOP-lowering medication users. The proportion of patients adherent (PDC > 0.80) to IOP-lowering medications was 51%. The study sample was split, using a 2:1 ratio, into a development sample (n = 48,840 members) and a validation sample (n=24,416 members). The model performed equally well in the development sample and the validation sample (area under the curve = 0.71 for development and validation sets), making it appear robust in this Medicare population. In the final predictive model, characteristics increasing the likelihood (P < 0.01) of nonadherence to IOP-lowering medication within the MAPD population included index IOP prescription filled through mail order, higher medical costs during the pre-index period, being a new IOP-lowering medication user, and being male. Characteristics that lowered the likelihood of nonadherence included advanced age, higher pharmacy costs during the pre-index period, receiving a low-income subsidy, residing in the South, and a previous diagnosis of open-angle glaucoma or history of glaucoma surgery. CONCLUSIONS: Nonadherence to topical IOP-lowering medication can be predicted with 10 commonly available demographic, clinical, and treatment-related variables generally available in administrative claims data for an MAPD population. Given that this predictive model was constructed using these generally available data, it could potentially be replicated by other health plans for use in predicting nonadherence to topical IOP-lowering medications among MAPD plan members. This predictive model can be used to identify members that are likely to be nonadherent in order to target interventions intended to improve ocular hypotensive medication adherence. DISCLOSURES: Funding for this study was contributed by Allergan. Comprehensive Health Insights was contracted by Allergan to conduct this study. Sheer, Bunniran, and Uribe are employed by Comprehensive Health Insights/Humana and own stock in Humana. Fiscella, Chandwani, and Patel are employed by Allergan. Study concept and design were contributed by Sheer, Fiscella, and Patel, along with Bunniran and Uribe. Sheer and Bunniran took the lead in data collection, and data interpretation was performed by Bunniran and Uribe, along with the other authors. The manuscript was written and revised by Sheer, Bunniran, Chandwani, and Uribe, with assistance from Fiscella and Patel.

Willingness to Exchange Health Information via Mobile Devices: Findings From a Population-Based Survey.

PURPOSE: The rapid proliferation of mobile devices offers unprecedented opportunities for patients and health care professionals to exchange health information electronically, but little is known about patients' willingness to exchange various types of health information using these devices. We examined willingness to exchange different types of health information via mobile devices, and assessed whether sociodemographic characteristics and trust in clinicians were associated with willingness in a nationally representative sample. METHODS: We analyzed data for 3,165 patients captured in the 2013 Health Information National Trends Survey. Multinomial logistic regression analysis was conducted to test differences in willingness. Ordinal logistic regression analysis assessed correlates of willingness to exchange 9 types of information separately. RESULTS: Participants were very willing to exchange appointment reminders (odds ratio [OR] = 6.66; 95% CI, 5.68-7.81), general health tips (OR = 2.03; 95% CI, 1.74-2.38), medication reminders (OR = 2.73; 95% CI, 2.35-3.19), laboratory/test results (OR = 1.76; 95% CI, 1.62-1.92), vital signs (OR = 1.63; 95% CI, 1.48-1.80), lifestyle behaviors (OR = 1.40; 95% CI, 1.24-1.58), and symptoms (OR = 1.62; 95% CI, 1.46-1.79) as compared with diagnostic information. Older adults had lower odds of being more willing to exchange any type of information. Education, income, and trust in health care professional information correlated with willingness to exchange certain types of information. CONCLUSIONS: Respondents were less willing to exchange via mobile devices information that may be considered sensitive or complex. Age, socioeconomic factors, and trust in professional information were associated with willingness to engage in mobile health information exchange. Both information type and demographic group should be considered when developing and tailoring mobile technologies for patient-clinician communication.

Characterization of Glaucoma Medication Adherence in Kaiser Permanente Southern California.

PURPOSE: To describe adherence to glaucoma medications. PATIENTS AND METHODS: Medication adherence was investigated using the computerized records of Kaiser Permanente Southern California, a group model health maintenance organization that provides care to 3.4 million residents of Southern California. Eligible glaucoma patients were diagnosed between 2005 and 2009 and had medical and prescription drug coverage between 2005 and 2009. Utilization and adherence parameters were calculated for each of the 5 years from the incident date. RESULTS: A total of 17,943 newly diagnosed glaucoma patients were identified between the years 2005 and 2009. Of patients diagnosed with glaucoma in 2005, 71% were continuously eligible for 5 years. Medication adherence was calculated using a medication possession ratio. Adherence was bimodal and not normal in distribution. Overall, the mean age of the entire group was 66 years, with 56% being 65 years of age or older. The high adherence group tended to be older, more likely to be female, and more likely to be white. The low adherent group (younger) tended to have more and worse diabetes, renal disease, myocardial infarction, and stroke. CONCLUSIONS: The shape of the adherence distribution appears bimodal, so analysis based on parametric measures may not be appropriate. Investigations of adherence should probably be performed separately for the low, mid, and high groups.

Consumer perspectives on personal health records: a 4-community study.

OBJECTIVES: To characterize consumer attitudes toward personal health records (PHRs) in 4 diverse communities across New York state (NYS). STUDY DESIGN: Combined analysis from four separate cross-sectional studies. METHODS: We analyzed pooled data from surveys separately administered to 4 NYS communities. Results from individual communities have been previously published. However, pooling the data allowed us to conduct multivariable regression analyses that identified key factors associated with potential usage among a broad group of consumers. RESULTS: We received responses from 701 consumers. A majority (74%) of respondents (n = 494) reported that they would use a PHR and the majority wanted a broad array of functionalities available. We found that potential PHR use was significantly associated with Internet use at least monthly (odds ratio [OR] = 5.8, 95% confidence interval [CI] = 3.3-10.2), a belief that PHRs may improve the security of health information (OR = 2.6, 95% CI = 1.5-4.7), and a belief that PHRs may improve quality of care (OR = 4.1, 95% CI = 2.6-6.6). CONCLUSIONS: As federal initiatives aim to improve healthcare, which includes making care more patient centered, PHRs will likely play an increasing role. Our results provide critical information to inform policy efforts, suggesting that PHRs must offer a broad range of patient-centered functionalities while maintaining high privacy and security standards to narrow the gap between reported interest and actual use. Ensuring widespread access to and frequent use of the internet among consumers will also be critical to avoid creating healthcare disparities through PHR use.

Impact of urinary incontinence on health-related quality of life, daily activities, and healthcare resource utilization in patients with neurogenic detrusor overactivity.

BACKGROUND: Neurogenic detrusor overactivity (NDO) leads to impaired health-related quality of life (HRQoL), productivity, and greater healthcare resource burden. The humanistic and economic burden may be more apparent in NDO patients with urinary incontinence (UI). The objective of this study was to compare the HRQoL, productivity, and health resource use (HRU) between continent and incontinent NDO patients. METHODS: A retrospective database analysis was conducted using the Adelphi Overactive Bladder (OAB)/UI Disease Specific Programme, a multi-national, cross-sectional survey reported from both patients' and physicians' perspectives. The population for this analysis included NDO patients with or without UI. General and disease-specific HRQoL were assessed using the EuroQoL-5D (EQ-5D), Incontinence Quality of Life questionnaire (I-QOL), and the Overactive Bladder Questionnaire (OAB-q). Productivity and daily activity impairment were measured using the Work Productivity and Activity Impairment (WPAI) questionnaire. HRU indicators included OAB-related surgery, OAB-related hospitalizations, incontinence pad usage, switching anticholinergics used for OAB due to inadequate response or adverse effects, and OAB-related physician visits. Bivariate analyses, multivariate ordinary least squares (OLS) regression analyses and published minimal clinically important differences (MCID) were used to assess relationships between incontinent status and the aforementioned outcome measures. RESULTS: A total of 324 NDO patients with or without urinary incontinence were included, averaging 54 years of age (SD 16), of whom 43.8 percent were male. Bivariate analyses detected no significant relationship between incontinent status and HRU variables. Regression analyses revealed that incontinent patients had clinically and statistically lower disease-specific HRQoL and greater impairment in daily activities as compared to continent patients. On average, incontinent patients scored 10 points lower on the I-QOL total score, 9 points lower on the OAB-q HRQoL score, 15 points higher on OAB-q symptom severity, and experienced 8.2 percent higher activity impairment due to their bladder condition (all p < 0.001). CONCLUSIONS: Incontinent NDO patients experience significantly lower HRQoL and activity impairment as compared to continent NDO patients.

Impact of urinary incontinence on healthcare resource utilization, health-related quality of life and productivity in patients with overactive bladder.

OBJECTIVE: To evaluate the impact of urinary incontinence (UI) on healthcare resource utilization (HRU), health-related quality of life (HRQoL) and productivity measures in patients with overactive bladder (OAB). PATIENTS AND METHODS: This retrospective, cross-sectional study used data from the Adelphi OAB/UI Disease Specific Programme, a multinational survey of patient- and physician-reported data, fielded between November 2010 and February 2011. The primary patient groups of interest were those with OAB, both with and without UI. Health-related quality of life and productivity measures were derived from the EuroQoL-5D, the Incontinence Quality of Life questionnaire, the Overactive Bladder Questionnaire, and the Work Productivity and Activity Impairment Questionnaire. Measures of HRU included OAB-related surgeries, OAB-related hospitalizations, incontinence pads, anticholinergic use and physician visits. Multivariate linear regression models and literature-based minimal clinically important differences were used to assess statistically significant and clinically meaningful differences in HRQoL and productivity measures between patients with OAB with UI and those without UI. RESULTS: A total of 1 730 patients were identified, with a mean age of 60.7 years, and 77.0% of them were women, 84.2% were non-Hispanic whites, and 71% were incontinent. Bivariate analyses showed that HRU was significantly higher among patients with OAB with UI than among those without UI in all categories except for the number of OAB-related physician visits. In both bivariate and multivariate analyses, incontinent patients presented with clinically and statistically significantly lower HRQoL and productivity measures with respect to all study endpoints, except for percentage of work time missed due to their OAB/UI. CONCLUSIONS: Urinary incontinence was associated with significantly higher HRU and lower HRQoL and productivity in this population of patients with OAB from five different countries. In addition to clinical considerations, the economic and humanistic impact of UI should be taken into account when evaluating treatment options for patients with OAB.

Physician experience with electronic health record systems that meet meaningful use criteria: NAMCS physician workflow survey, 2011.

KEY FINDINGS: Data from the National Ambulatory Medical Care Survey's (NAMCS) Physician Workflow Survey, 2011. About three-quarters of physicians with electronic health record (EHR) systems have systems that meet meaningful use criteria. Physicians with EHR systems that meet meaningful use criteria were more likely to report that their system provides time savings than physicians with systems not meeting meaningful use criteria, but only in some areas. Physicians with EHR systems that meet meaningful use criteria were more likely to report enhanced confidentiality and less disruption in their interactions with patients than physicians with systems not meeting meaningful use criteria. Physicians with EHR systems that meet meaningful use criteria were no more likely to report financial benefits and selected clinical benefits than those with systems not meeting meaningful use criteria.

Office-based physicians are responding to incentives and assistance by adopting and using electronic health records.

Expanding the use of interoperable electronic health record (EHR) systems to improve health care delivery is a national policy priority. We used the 2010-12 National Ambulatory Medical Care Survey--Electronic Health Records Survey to examine which physicians in what types of practices are implementing the systems, and how they are using them. We found that 72 percent of physicians had adopted some type of system and that 40 percent had adopted capabilities required for a basic EHR system. The highest relative increases in adoption were among physicians with historically low adoption levels, including older physicians and those working in solo practices or community health centers. As of 2012, physicians in rural areas had higher rates of adoption than those in large urban areas, and physicians in counties with high rates of poverty had rates of adoption comparable to those in areas with less poverty. However, small practices continued to lag behind larger practices. Finally, the majority of physicians who adopted the EHR capabilities required to obtain federal financial incentives used the capabilities routinely, with few differences across physician groups.

An adherence based cost-consequence model comparing bimatoprost 0.01% to bimatoprost 0.03%.

OBJECTIVES: Estimate the long-term direct medical costs and clinical consequences of improved adherence with bimatoprost 0.01% compared to bimatoprost 0.03% in the treatment of glaucoma. METHODS: A cost-consequence model was constructed from the perspective of a US healthcare payer. The model structure included three adherence levels (high, moderate, low) and four mean deviation (MD) defined health states (mild, moderate, severe glaucoma, blindness) for each adherence level. Clinical efficacy in terms of IOP reduction was obtained from the randomized controlled trial comparing bimatoprost 0.01% with bimatoprost 0.03%. Medication adherence was based on observed 12 month rates from an analysis of a nationally representative pharmacy claims database. Patients with high, moderate and low adherence were assumed to receive 100%, 50% and 0% of the IOP reduction observed in the clinical trial, respectively. Each 1 mmHg reduction in IOP was assumed to result in a 10% reduction in the risk of glaucoma progression. Worse glaucoma severity health states were associated with higher medical resource costs. Outcome measures were total costs, proportion of patients who progress and who become blind, and years of blindness. Deterministic sensitivity analyses were performed on uncertain model parameters. RESULTS: The percentage of patients progressing, becoming blind, and the time spent blind slightly favored bimatoprost 0.01%. Improved adherence with bimatoprost 0.01% led to higher costs in the first 2 years; however, starting in year 3 bimatoprost 0.01% became less costly compared to bimatoprost 0.03% with a total reduction in costs reaching US$3433 over a lifetime time horizon. Deterministic sensitivity analyses demonstrated that results were robust, with the majority of analyses favoring bimatoprost 0.01%. Application of 1 year adherence and efficacy over the long term are limitations. CONCLUSIONS: Modeling the effect of greater medication adherence with bimatoprost 0.01% compared with bimatoprost 0.03% suggests that differences may result in improved economic and patient outcomes.

Cost-offset analysis: bimatoprost versus other prostaglandin analogues in open-angle glaucoma.

OBJECTIVES: To develop a cost-offset model from a US payer perspective comparing glaucomatous progression and costs among primary open-angle glaucoma (POAG) patients using bimatoprost, latanoprost, or travoprost. STUDY DESIGN: Cost-offset model. METHODS: A Markov cohort model was used to estimate glaucomatous progression for POAG patients over 7 years. The model assumed bimatoprost-treated patients had lower resulting intraocular pressure (IOP) (by 1 mm Hg) for all presenting IOP categories than latanoprost- or travoprost-treated patients. Patients with lower IOP were assumed to have lower probability of progression. Those that progressed were assumed to do so at a rate of -0.6 dB per year. Direct costs associated with mean deviation score categories were applied to each treatment cohort to calculate the expected 7-year costs of treating patients with each prostaglandin analogue (PGA). Literature was used to support assumptions. A budget impact analysis was conducted where all travoprost patients switched to generic latanoprost and where all bimatoprost patients switched to generic latanoprost. The base case market share was 22% bimatoprost, 23% travoprost, and 55% latanoprost. RESULTS: Model results demonstrate that for a managed care plan with 9500 PGA-treated glaucoma patients, exclusive bimatoprost use would prevent progression in 136 additional individuals compared with exclusive travoprost or latanoprost treatment. Model results demonstrate that greater IOP reduction from bimatoprost is associated with increased cost savings compared with latanoprost or travoprost treatments. CONCLUSIONS: Model results demonstrate that greater IOP reduction from bimatoprost could reduce managed care spending.

Low-income, ethnically diverse consumers' perspective on health information exchange and personal health records.

We surveyed low-income, ethnically diverse consumers regarding their attitudes towards providers' use of electronic health information exchange (HIE) and consumer use of HIE through personal health records (PHRs). Amongst respondents (n=214), 48% had an annual household income below $15,000 and 62% spoke a language other than English at home. A majority indicated that they supported providers' use of HIE (61%). Support for providers' use of HIE was independently associated with consumer willingness to permit health care providers other than their primary care doctor to view their electronic medical record information (odds ratio (OR)=2.92, 95% confidence interval (CI)=1.31-6.50) and beliefs that electronic health record use would improve quality of care (OR=2.70, 95% CI=1.18-6.18). Seventy-eight percent would potentially use PHRs. Potential PHR use was independently associated with Internet usage rates, (OR=4.46, 95% CI=1.77-11.22), belief that PHR use would improve their understanding of their own healthcare (OR=3.12, 95% CI=1.27-7.67) and comfort with sharing PHR data with their primary care doctor (OR=2.79, 95% CI=1.09-7.11). Low-income, ethnically diverse consumers affected by interoperable health information technology (IT) initiatives largely support using PHRs and HIE, provided these systems demonstrate benefits and address the privacy and security of their electronic health information. Although we found interest in PHRs comparable or higher than nationally representative populations, support for HIE was lower, and thus efforts will need to be made to engage low-income and ethnically diverse consumers to participate in interoperable health IT initiatives.

Consumer attitudes toward personal health records in a beacon community.

OBJECTIVE: To characterize consumers' attitudes about personal health records (PHRs), electronic tools that enable consumers to securely access, manage, and share their health information, in a community participating in health information technology initiatives. STUDY DESIGN: Cross-sectional study. METHODS: A random-digit-dial telephone survey about PHRs was conducted among adult residents of New York State's greater Buffalo region. Multivariate regression analyses identified factors associated with potential PHR use. RESULTS: We obtained a 79% (n = 200) response rate. Many respondents (70%) would potentially use PHRs. Consumers wanted PHRs to incorporate an array of information, including immunization records (89%) and providers visited (88%). They expressed interest in several online activities, including accessing their family members' healthcare information (71%). Potential PHR use was associated with perceptions that PHRs would improve privacy and security of medical information (odds ratio [OR] 4.7; 95% confidence interval [CI] 1.1, 20.1), understanding regarding health (OR 3.7; 95% CI 1.3, 11.1), and overall quality of care (OR 3.6; 95% CI 1.2, 10.6). Potential PHR use was associated with annual household income of more than $30,000 (OR 3.9; 95% CI 1.3, 11.9) and experience looking up health information online (OR 3.0; 95% CI 1.1, 8.1). CONCLUSIONS: Consumers expressed great interest in using PHRs and wanted comprehensive PHRs. However, the "digital divide" between those with varying levels of Internet experience and concerns about PHRs' effect on privacy and security of medical information may limit use. Designing PHRs that incorporate consumer preferences and developing policies that address these barriers may increase consumers' PHR use.