Disparities in Use of a Personal Health Record in a Managed Care Organization
- Douglas W Roblin, PhDa,
- Thomas K Houston II, MD, MPHb,c,
- Jeroan J Allison, MD, MScb,
- Peter J Joski, MSPHa,
- Edmund R Becker, PhDd
- aCenter for Health Research/Southeast, Kaiser Permanente Georgia, Atlanta, GA
- bSchool of Medicine, University of Alabama at Birmingham, Birmingham, AL
- cBirmingham VA Research Award Enhancement Program, Birmingham, AL
- dRollins School of Public Health, Emory University, Atlanta, GA
- Correspondence: Thomas K. Houston, MD, MPH, Associate Professor of Medicine, 1530 3rd Ave South, FOT 720, University of Alabama at Birmingham, Birmingham, AL 35294 (Email: thouston{at}uab.edu).
- Received 5 February 2009
- Accepted 2 June 2009
Abstract
Objective Personal health records (PHRs) can increase patient access to health care information. However, use of PHRs may be unequal by race/ethnicity.
Design The authors conducted a 2-year cohort study (2005–2007) assessing differences in rates of registration with KP.org, a component of the Kaiser Permanente electronic health record (EHR).
Measurements At baseline, 1,777 25–59 year old Kaiser Permanente Georgia enrollees, who had not registered with KP.org, responded to a mixed mode (written or Internet) survey. Baseline, EHR, and KP.org data were linked. Time to KP.org registration by race from 10/1/05 (with censoring for disenrollment from Kaiser Permanente) was adjusted for baseline education, comorbidity, patient activation, and completion of the baseline survey online vs. by paper using Cox proportional hazards.
Results Of 1,777, 34.7% (616) registered with KP.org between Oct 2005 and Nov 2007. Median time to registering a KP.org account was 409 days. Among African Americans, 30.1% registered, compared with 41.7% of whites (p < 0.01). In the hazards model, African Americans were again less likely to register than whites (hazard ratio [HR] = 0.652, 95% CI: 0.549–0.776) despite adjustment. Those with baseline Internet access were more likely to register (HR = 1.629, 95% CI: 1.294–2.050), and a significant educational gradient was also observed (more likely registration with higher educational levels).
Conclusions Differences in education, income, and Internet access did not account for the disparities in PHR registration by race. In the short-term, attempts to improve patient access to health care with PHRs may not ameliorate prevailing disparities between African Americans and whites.
Footnotes
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Funding for this study has been provided through grants from the Kaiser Permanente HealthConnect Research Initiative (JJ Allison, PI) and the Health Promotion Research Initiative of the Centers for Disease Control and Prevention (1R01CD000033, ER Becker, PI), the Veterans Administration Health Services Research and Development (REA 04–195, TK Houston Co-PI). The study was previously presented at the AcademyHealth Annual Research Meeting, Washington, DC, Jun 10, 2008. All authors declare no conflict of interest.
