Racial, ethnic, gender, language, socioeconomic, and geographic disparities in cardiovascular health are well documented, and a cause for great public health concern. Traditional population-based methods of monitoring disparities are inadequate for understanding the causal pathways among the myriad of influences on health. More detailed clinical and health information is needed to understand how health-related policies and reforms affect disparities. Massachusetts (MA) is the scene of one of the most significant natural experiments in health reform in the nation, and is the ideal setting in which to monitor and evaluate the cardiovascular disease (CVD) and risk factor disparities associated with such policy changes, in addition to those wrought by the current economic downturn. We propose to develop an extensive, de-identified, easily accessible database including information about child and adult residents using clinical data from:1) New England's largest safety net hospital, Boston Medical Center, and its affiliated community health centers;2) another large academic tertiary care system, University of Massachusetts Medical Center in central MA whose patient population is more white and middle class;and 3) claims data from the BMC Health Plan, the largest statewide provider of the new insurance product for low income individuals. We will use i2b2, an open-source, scalable informatics platform offering a broad array of translational informatics tools including a clinical data repository and a standard ontology. I2b2's data structure, ontology, and query (analytic) tools allow the integration and analysis of massive amounts of de-identified data from disparate systems, and present a radical advance in the ability to use clinical data for disparities monitoring. Furthermore, all i2b2 systems share a common architecture;data, queries, and software tools can be shared between systems to support inter-institutional disparities research. We will test the feasibility of applying this novel resource for disparities monitoring for common CVD risk factors and chronic conditions which lead to substantial morbidity and mortality, where there are known disparities, and which the national public health goals of HP2010 seek to improve: hypertension, hyperlipidemia, obesity/overweight, and tobacco use. We have three primary aims: 1) Develop a powerful infrastructure to monitor CVD risk factors and outcomes. Using i2b2, we will create a large, longitudinal, statewide de-identified database, and develop new software tools and resources to monitor and analyze pediatric and adult health disparities;2) Explore the effects of health reform and the economic downturn on disparities in health outcomes. We will examine changes in health insurance coverage and health disparities during pre- and post-reform periods, and periods before and into the current economic downturn;3) Develop strategies for sharing tools and communicating results to policy makers, health care providers, and the research community.
Project Narrative Our proposed project will create a unique, integrated data system by which to monitor and evaluate health disparities. The disparities monitoring data we will provide access to can be used to observe local, even community level, changes in disparities over time, examine the impact of policy changes, and better understand how screening and receipt of care are related to disparities. The national impact we anticipate will come from the process and tools we develop, which can be shared and implemented nationally for other states to conduct similarly detailed monitoring of disparities in their settings.
| Kressin, Nancy R; Lasser, Karen E; Paasche-Orlow, Michael et al. (2015) Clinical Operations Variables are Associated With Blood Pressure Outcomes. Med Care 53:480-4 |
| Mann, Devin M; Glazer, Nicole L; Winter, Michael et al. (2013) A pilot study identifying statin nonadherence with visit-to-visit variability of low-density lipoprotein cholesterol. Am J Cardiol 111:1437-42 |
