Factors Associated with Electronic Personal Health Record Use among Registered Nurses for Their Own Health Management
Abstract
Background: Electronic personal health records (ePHRs) are consumer-centric tools that enable consumers to securely access, manage and share their health information with health care providers. Although the potential for ePHRs to improve healthcare is significant, there is no available evidence on health care professionals' use of ePHRs for their own health management. Nurses have a tremendous opportunity to assist and educate patients in ePHRs. Research has shown that ePHR adoption among patients were influenced by perceived usefulness and ease of use using the technology acceptance model (TAM). This study expanded the TAM adding perceived data privacy security protections and health promoting role models for the ePHR acceptance model. Purpose: This study examined (1) characteristics associated with ePHR use by nurses: health, technology experience, and attitudes about privacy of electronic health information, (2) psychometric properties of the measures in the research model, (3) association of ePHR acceptance constructs: perceived usefulness, ease of use, data privacy and security protections, and health promoting role model with ePHR use, and (4) moderating effects of nurses characteristics: age, chronic illness and/or medication use, providers use of electronic personal health record (EHR) on the relationships between ePHR acceptance constructs and ePHR use. Methods: Registered nurses working in hospitals and members of the nursing informatics community (NIC) completed an anonymous online survey in the Fall of 2013 (n=847). Differences between groups were examined using t-tests and χ² tests. The associations between nurses' characteristics and ePHR use were examined via multiple logistic regression models that also held constant possible confounding covariates and interaction terms. Results: Less than half (41%) of the hospital nurses were ePHR users. The odds of ePHR use was significantly greater among those with chronic medical conditions/medication use (OR=1.64, 95% CI=1.06-2.53) and those whose health care providers used EHRs (OR=3.62, 95% CI=2.45-5.36) controlling for age, marital status, current positions and specialty area. ePHR use was more common among NIC nurses (72%). The odds of ePHR use was also increased among NIC nurses with providers that used EHRs (OR=5.99, 95% CI=1.40-25.61), but users were 70% less concerned about privacy of health information online than nonusers (OR=0.32, 95% CI=0.14-0.70) controlling for ethnicity, race and practice regions. The majority of both ePHR users and nonusers would grant access to their primary care providers. However, fewer ePHR users in both nursing groups granted permission to designated family members or friends, other care providers who care for them, or pharmacists to view ePHRs than nonusers who answered hypothetically. Sufficient reliability for usefulness, ease of use, and privacy and security protections, and health promoting role model scales were found (all Cronbach alphas>0.70). Three constructs contributed significantly to ePHR use after adjusting nursing group, age, chronic illness and medication use, and health care providers use of EHR (usefulness, OR=0.87, 95% CI=0.85-0.89; data privacy and security protection, OR=1.04, 95% CI=1.01-1.07; and health promoting role model, OR=1.07, 95% CI=1.04-1.11). Significant interactions existed between perceived data privacy and security protections and providers EHR use, and between perceived health promoting role model and age on ePHR use (p<0.05). Conclusion: The study findings suggest practical insights for nurses. With the experience of using ePHRs, nurses can leverage use of ePHRs for patient education on chronic illness and medication management. Nurses in NIC can also play an important role in practical ePHR design to enhance functionality and security in ePHR with their specialties in nursing informatics.Description
University of Maryland, Baltimore. Nursing. Ph.D. 2014Keyword
data privacy and securityelectronic personal health record
health care providers
health promoting role model
hospital nurses
EHR
Nursing informatics
Electronic Health Records
Identifier to cite or link to this item
http://hdl.handle.net/10713/4174Related items
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The impact of the state of Maryland's Medicaid mental health carve-out on access-to-care for patients in a suburban health care systemIn recent years, providing care for individuals with severe mental illness has consumed increasing state and federal financial resources, with State Medicaid systems bearing the heaviest burden. Managed care strategies have been initiated by public mental health systems as a mechanism to control expenses. The state of Maryland implemented a mental health carve-out on July 1, 1997. The purpose of the present study is to describe the effects of the carve-out on access-to-care for individuals using emergency department services in one suburban health care system. Data for this study included all episodes of emergency crisis care in pre-implementation (1996-1997) and post-implementation (1998-1999) time periods. These data were examined within the context of the Behavioral Model of Health Service Use (Andersen, 1995) to describe the interrelationships among external environment, predisposing characteristics, and enabling resources on use of health services. Use of health services was operationalized by four outcomes: disposition, length of stay, number of visits, and recidivism. There were a total of 2986 episodes, initiated by 1928 individuals. Logistic regression demonstrated that when controlling for predisposing characteristics and enabling resources, the likelihood of inpatient admission did not change after initiation of the program. Moreover, there was not a significant change in the number of emergency visits. The assessment of recidivism demonstrated that only psychotic disorders (a predisposing characteristic) were a significant predictor of 30-day repeat visits. Multiple regression models examining the impact of the carve-out on length of stay demonstrated a significant increase in the emergency department length of stay (F = 5.47, p = .05) following the implementation of the carve-out. While benefits associated with improved coordination of services might be expected with the implementation of the carve-out, there was not a change in inpatient admissions, number of emergency visits, or recidivism. Additionally, there was a significant increase in the amount of time required to assess patients and to provide an appropriate disposition. The limited study sample and data prohibit generalizability. Considering that evaluations of mental health carve-outs are limited, this study reflects that anticipated benefits have not been experienced in emergency departments.
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Costs, outcomes and estimation of the cost-effectiveness of abciximab in the prevention of ischemic events over six months of follow-upAbciximab is an antiplatelet inhibitor used in conjunction with percutaneous revascularization procedures to decrease the risk of ischemic complications such as death, nonfatal MI or subsequent revascularization procedures like angioplasty or CABG. Although the efficacy of abciximab is rarely disputed based on evidence from three large clinical trials, the cost-effectiveness of the drug when used during routine practice has been questioned since it costs approximately $1,350 per patient treated. This study was undertaken to estimate the effectiveness of abciximab in patients treated at University of Maryland Medical System (UMMS) and to estimate the incremental cost-effectiveness ratio (ICER) defined as the cost per event avoided. The composite endpoint consisted of death, MI or subsequent revascularization procedure over 6-months of follow-up. Proportional hazards regression revealed that abciximab was associated with a lower risk of ischemic events among patients with more severe angiographic morphology. Patients who received a shortened infusion of the drug (<10 hours) were at a greater risk of experiencing an event than those who received an infusion for 10-14 hours. Also, patients who underwent coronary stenting were less likely to have an event while patients with multivessel disease or a history of a percutaneous revascularization procedure were at a higher risk of experiencing an event. The cost-effectiveness analysis was performed for a subgroup of patients with more severe coronary morphology using a matched cohort design. The point estimate of the ICER revealed that it cost about $20,680 to prevent an ischemic event over six months in high-risk patients treated with abciximab. Confidence intervals for the ICER were computed using Taylor series approximation, Fieller's theorem and bootstrapping, and were graphically represented with ellipses of equal probability. Overall, the data were consistent with a wide range of plausible estimates due to a relatively small denominator in the ICER.
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Development of a measure of the content and quality of prenatal care services in a Medicaid populationStatement of the problem. The purpose of this study was to develop an instrument to measure the content and quality of prenatal care services in a population of low income women. Dimensions of performance as proposed by the Joint Commission on Accreditation of Healthcare Organizations were used to define the quality of prenatal care. The United States Public Health Service Expert Panel Guidelines on the Content of Prenatal Care were used as the standard for the content of care. Methods. The Content and Quality of Prenatal Care Measure (CQPM), a prenatal care record review measure, was developed in this study. An assessment of content validity and intra- and inter-rater reliability was completed. Data collected for the validity sample of 163 records at two county health department sites was scored by content area. The Adequacy of Prenatal Care Utilization Index (APNCU) developed by Kotelchuck was used to categorize each record in the validity sample. Criterion-related validity was assessed with ANOVA using the CQPM scores as the dependent variable and the APNCU groups as the independent variable and by discriminant function analysis using the CQPM content scores as predictors for group membership in APNCU groups. Results. The mean percent agreement for each of the content areas for intra- and inter-rater reliability ranged from 72% to 95% with medical risk assessment having the highest reliability and health promotion having the lowest. Intra and inter-rater percent agreement for items ranking the quality of care was 70% and 51.6%. A significant difference between the groups was found in ANOVA, F(3,157):16.23, p < .00001, confirming criterion-related validity. The discriminant function analysis found an overall Lambda =.451941 (chi2 = 110.79, df 15, p < .00001). The prediction equation accounted for 62% of grouped cases being correctly classified also confirming criterion-related validity. Discussion. These results show that the Content and Quality of Prenatal Care Measure is reliable and valid and may be used to monitor care provided to low income populations and to conduct research on the content of prenatal care. Further research on weighting each item score in the CQPM and the reliability of items for special populations may be indicated.