As implemented, outside of a handful of reference institutions, electronic health record (EHR) systems have not been conclusively shown to improve health outcomes. The New York City Primary Care Information Project (PCIP) is the nation's largest community EHR extension project, with 148 primary care practices and over 1,000 providers in some of the city's poorest neighborhoods. The PCIP's goal is to maximize improvements in the quality of care through this investment of public funds. This public health perspective has led to development and implementation of clinical decision support and integrated registry tools, quality benchmarking, onsite technical assistance in quality improvement and practice redesign, and a novel reward and recognition program. In essence, the PCIP aims to provide even small independent practices with the health system advantages enjoyed by integrated health care organizations. The PCIP is evaluating trends in priority quality measures (e.g., blood pressure and lipid control) among 90 small practices randomized to receive clinical decision support tools and/or financial rewards. This proposed study of 60 comparison practices that have not adopted EHRs will provide a unique opportunity to demonstrate the potential of appropriately implemented health information technology for improving quality of care and reducing health disparities in a large community EHR program.

Public Health Relevance

Research and Related: Other Project Information 7. Project Narrative The Primary Care Information Project, within the New York City Department of Health and Mental Hygiene, has implemented electronic health records (EHRs) in over 1,000 providers in New York City. This study will use data collected from 60 practices that have not adopted EHRs as a comparison reference to disentangle the independent effects and unique contribution of EHR adoption, integration of a clinical decision support system, and quality incentives focused on cardiovascular care measures.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Demonstration and Dissemination Projects (R18)
Project #
5R18HS018275-03
Application #
8131107
Study Section
Health Care Technology and Decision Science (HTDS)
Program Officer
Rosenthal, Vera
Project Start
2009-09-30
Project End
2013-07-31
Budget Start
2011-08-01
Budget End
2013-07-31
Support Year
3
Fiscal Year
2011
Total Cost
Indirect Cost
Name
New York City Health/Mental Hygiene
Department
Type
DUNS #
083489737
City
New York
State
NY
Country
United States
Zip Code
10013
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Ryan, Andrew M; McCullough, Colleen M; Shih, Sarah C et al. (2014) The intended and unintended consequences of quality improvement interventions for small practices in a community-based electronic health record implementation project. Med Care 52:826-32
Bardach, Naomi S; Wang, Jason J; De Leon, Samantha F et al. (2013) Effect of pay-for-performance incentives on quality of care in small practices with electronic health records: a randomized trial. JAMA 310:1051-9
Begum, Rohima; Smith Ryan, Mandy; Winther, Chloe H et al. (2013) Small practices' experience with EHR, quality measurement, and incentives. Am J Manag Care 19:eSP12-8