Driven by the Health Information Technology for Economic and Clinical Health (HITECH) Act large numbers of physicians and hospitals are now implementing electronic health records (EHR) with the general expectation that such systems will improve the quality, safety and efficiency of health care services. Studies of conversions from paper to electronic records paint a mixed picture with healthcare providers pleased with some aspects of their EHRs but dissatisfied with others. These prior studies focused on conversions from paper to electronic records. Many provider impressions, therefore, may have been influenced by reactions to the process of being required to change well established patterns. In order to help separate such reactions from true evaluations of the efficacy of the EHR, we decided to survey the providers in a new health center. To insure that the information gathered was not merely anecdotal, we used a well-established format starting with a semi-structured interview which facilitates analysis and recognition of major themes. We included questions around several important areas including workflow, communication, patient satisfaction, productivity, documentation, and quality of care. Ten main themes emerged: impeding patient flow, hindering communication in office, improving communication after the visit, improving tracking of patient care, spending less time with patients, requiring more training, wanting more features, diminishing productivity, appreciating benefits of templates, and enhancing internal communication. The need for better training appeared to be of especially high importance as it impacted several of the other themes. We believe that our study helps validate the similar concerns expressed in studies of transitions from paper to electronic record systems. Our method may be generally useful to other clinics because it facilitates timely recognition of themes, both positive and negative, that clinicians and clinic managers would want to know at an early stage. Prompt knowledge of such developing themes may help to accentuate the positive aspects of the EHR and to prevent negative themes from developing into serious problems that might be considered serious unintended consequences of EHR usage.

BackgroundThe large number of uninsured individuals in the United States creates negative consequences for those who are uninsured and for those who are covered by health insurance plans. Young adults between the ages of 18 and 24 are the largest uninsured population subgroup. This subgroup warrants analysis. The major aim of this study is to determine why young adults between the ages of 18 and 24 are the largest uninsured population subgroup.MethodsThe present study seeks to determine why young adults between the ages of 18 and 24 are the largest population subgroup that is not covered by private health insurance. Data on perceived health status, perceived need, perceived value, socioeconomic status, gender, and race was obtained from a national sample of 1,340 young adults from the 2005 Medical Expenditure Panel Survey and examined for possible explanatory variables, as well as data on the same variables from a national sample of 1,463 from the 2008 Medical Expenditure Panel Survey.ResultsResults of the structural equation model analysis indicate that insurance coverage in the 2005 sample was largely a function of higher socioeconomic status and being a non-minority. Perceived health status, perceived need, perceived value, and gender were not significant predictors of private health insurance coverage in the 2005 sample. However, in the 2008 sample, these indicators changed. Socioeconomic status, minority status, perceived health, perceived need, and perceived value were significant predictors of private health insurance coverage.ConclusionsThe results of this study show that coverage by a private health insurance plan in the 2005 sample was largely a matter of having a higher socioeconomic status and having a non-minority status.In 2008 each of the attitudinal variables (perceived health, perceived value, and perceived need) predicted whether subjects carried private insurance. Our findings suggest that among those sampled, the young adult subgroup between the ages of 18 and 24 does not necessarily represent a unique segment of the population, with behaviors differing from the rest of the sample.

Objective: Quality improvement in the healthcare industry has evolved over the past few decades. In recent years, an increased focus on coordination of care efforts and the introduction of health information technology has been of high importance in improving the quality of patient care. Methods: In this review, we present a history of quality improvement efforts, discuss quality improvement in the healthcare industry, and examine quality improvement strategies with a focus on patient-centered care and information technology applications via patient registries. Results: Evidence shows that the key to quality improvement efforts in the healthcare industry is the coordination of patient care efforts through better data evaluation processes. By utilizing patient registries that can be linked to electronic health records (EHRs) and the Patient-Centered Medical Home (PCMH) framework, the quality of care provided to patients can be improved. Conclusions: While many healthcare organizations have quality improvement departments or teams in place that may be able to handle these types of efforts, it is important for organizations to be familiar with processes and frameworks that employees at different levels of the organization can be involved in. In order to ensure successful outcomes from quality improvement initiatives, managers and clinicians should work together in identifying problems and developing solutions.

Objectives It is estimated that 20% of children in the USA are affected by at least one chronic disease. Although the burden of chronic conditions is greater for minority populations of children, research that has explored the prevalence and risk factors of chronic disease across different racial/ethnic groups is scarce. The aim of this study was to examine racial/ethnic disparities in the prevalence rates of common physical, chronic diseases in White, Black and Hispanic children; and assess the effect of several factors on the risk of having a chronic disease. Methods Using the 2007 National Survey of Childrens Health, prevalence estimates were calculated for asthma, hearing impairment, visual impairment, joint/bone/muscle problems, brain injury and other illnesses for each racial/ethnic group. Multivariate logistic regression analyses were conducted to examine the effects of several risk factors on the risk of each of these health conditions. Results The findings show that the prevalence for all health conditions was significantly higher (25.3%) among Black children than White (19.8%) and Hispanic (18.6%) children. Furthermore, 19.5% of Black children have had or currently have asthma compared with 12.2% of White and Hispanic children. More Black and Hispanic children were covered by public health insurance, while 19% of Hispanic children were currently uninsured. White children whose mothers had a health problem were associated with asthma, hearing impairment, visual impairment and joint/bone/muscle problems, while Black children were more likely to report asthma and Hispanics reported visual impairment and joint/ bone muscle problems. Hispanic children who were living in poverty or were uninsured were at lower risk for any chronic disease. Regardless of race/ethnicity, children living in a single-parent household were more likely to be associated with any health condition.\ Conclusions This study provides evidence that racial/ethnic disparities in chronic physical conditions and health care among US children are extensive. It underscores that uninsured children who do not have access to the healthcare system are not being screened for chronic diseases, or are not obtaining medical care for such health problems. Healthcare providers should educate families about prevention measures and community services that might be able to assist them in improving the health of their children.

This article provides a detailed examination of the pros and cons associated with patient-centered medical homes (PCMHs). Opinions and findings from those who have studied PCMHs and those who have been directly involved with this type of health care model are outlined. Key lessons from providers are detailed, and critical success factors are highlighted. This synthesized analysis serves to lend evidence to health care managers and providers who are considering implementation of the PCMH model.