Physicians in nonprimary care and small practices and those age 55 and older lag in adopting electronic health record systems.

By 2011 more than half of all office-based physicians were using electronic health record systems, but only about one-third of those physicians had systems with basic features such as the abilities to record information on patient demographics, view laboratory and imaging results, maintain problem lists, compile clinical notes, or manage computerized prescription ordering. Basic features are considered important to realize the potential of these systems to improve health care. We found that although trends in adoption of electronic health record systems across geographic regions converged from 2002 through 2011, adoption continued to lag for non-primary care specialists, physicians age fifty-five and older, and physicians in small (1-2 providers) and physician-owned practices.

Most physicians were eligible for federal incentives in 2011, but few had EHR systems that met meaningful-use criteria.

As more physicians adopt electronic health record systems in their practices, policy interest is focusing on whether physicians are ready to meet the federal "meaningful use" criteria--a vital threshold to qualify for financial incentives. In our analysis of a 2011 nationally representative survey of office-based physicians, we found that 91 percent of physicians were eligible for Medicare or Medicaid meaningful-use incentives. About half of all physicians intended to apply.

Nurse-led disease management for hypertension control in a diverse urban community: a randomized trial.

Background: Treated but uncontrolled hypertension is highly prevalent in African American and Hispanic communities.

Objective: To test the effectiveness on blood pressure of home blood pressure monitors alone or in combination with follow-up by a nurse manager.

Design: Randomized controlled effectiveness trial.

Trends in diabetes treatment patterns among primary care providers.

Using data from the National Ambulatory Medical Care Survey, logit models tested for trends in the probability that visits by adult diabetes patients to their primary care providers included recommended treatment measures, such as a prescription for an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin-II receptor blocker (ARB), blood pressure measurement, and diet/nutrition or exercise counseling. Results indicated that the probability that visits included prescription of an ACE or ARB and blood pressure measurement increased significantly over the 1997-2005 period, while the probability that visits documented provision of exercise counseling rose since 2001.

Use of medical care for chronic conditions.

We used nationally representative data from the National Center for Health Statistics to compare 1995-96 and 2005-06 ambulatory care visit and 1996 and 2006 hospital discharge rates for adults for eight major chronic conditions. For the eight conditions combined, ambulatory care visit rates rose 21 percent, while hospital discharge rates fell 9 percent. Discharge rates fell for heart disease, cancer, and cerebrovascular disease.

Cost-effectiveness of nurse-led disease management for heart failure in an ethnically diverse urban community.

Background: Randomized, controlled trials have shown that nurse-led disease management for patients with heart failure can reduce hospitalizations. Less is known about the cost-effectiveness of these interventions.

Objective: To estimate the cost-effectiveness of a nurse-led disease management intervention over 12 months, implemented in a randomized, controlled effectiveness trial.

Collecting adequate data on racial and ethnic disparities in health: the challenges continue.

Data limitations continue to pose challenges for efforts to identify racial and ethnic disparities in health and health care and analyze the underlying causes. Given budget constraints, the most feasible federal strategies to improve national data are those requiring only modest expenditures. Collaborations among private and public stakeholders hold promise for improving estimation methods and assessing disparities among small populations.

When does a difference become a disparity? Conceptualizing racial and ethnic disparities in health.

Definitions of racial and ethnic disparities fall along a continuum from differences with little connotation of being unjust to those that result from overt discrimination. Where along this continuum one decides that a racial difference becomes a disparity is subjective, but the magnitude of the injustice is generally proportional to how much control a person is perceived to have over the cause of the difference in health. The degree to which one sees environmental factors and social context as shaping choices has important implications for the measurement of disparities and ultimately for directing efforts to eliminate them.

The success of recruiting minorities, women, and elderly into a randomized controlled effectiveness trial.

Background: Heart failure, a leading cause of hospitalization among elderly people, disproportionately afflicts African-American and other non-White populations. Studies of health care interventions often do not include these groups in proportion to numbers in the patient population. Our objective was to assess whether a randomized controlled effectiveness trial enrolled patients by ethnicity/race, gender, and age in proportion to those eligible.

Hypertension management in minority communities: a clinician survey.

Background: Rates of blood pressure (BP) control are lower in minority populations compared to whites.

Objective: As part of a project to decrease health-related disparities among ethnic groups, we sought to evaluate the knowledge, attitudes, and management practices of clinicians caring for hypertensive patients in a predominantly minority community.

Design/participants: We developed clinical vignettes of hypertensive patients that varied by comorbidity (type II diabetes mellitus, chronic renal insufficiency, coronary artery disease, or isolated systolic hypertension alone).

Effects of nurse management on the quality of heart failure care in minority communities: a randomized trial.

Background: Despite therapies proven effective for heart failure with systolic dysfunction, the condition continues to cause substantial hospitalization, disability, and death, especially among African- American and other nonwhite populations.

Objective: To compare the effects of a nurse-led intervention focused on specific management problems versus usual care among ethnically diverse patients with systolic dysfunction in ambulatory care practices.

Design: Randomized effectiveness trial conducted from September 2000 to September 2002.

Which physicians and practices are using electronic medical records?

Greater use of electronic medical records (EMRs) has the potential to improve the quality of medical care and has become a goal of the U.S. administration.

How do urban African Americans and Latinos view the influence of diet on hypertension?

Uncontrolled hypertension and its complications continue to be major health problems that disproportionately affect poor minority communities. Although dietary modification is an effective treatment for hypertension, it is not clear how hypertensive minority patients view diet as part of their treatment, and what barriers affect their abilities to eat healthy diets. We conducted nine focus groups with 88 African American and Latino patients treated for hypertension to assess their knowledge, attitudes, behaviors, and beliefs concerning hypertension.

Implementing evidence-based practice: evaluation of an opinion leader strategy to improve breast-feeding rates.

Objective: The objective was to evaluate the effectiveness of opinion leaders in raising breast-feeding rates.

Study Design: A randomized controlled trial of an opinion leader strategy in 18 hospitals in Central New York State compared mothers' intention to breast-feed during baseline and study years. Multivariate logistic regression with a mixed model analyzed the effects on breast-feeding exclusively and on breast- and formula-feeding combined.

Cost-effectiveness of vaccination against invasive pneumococcal disease among people 50 through 64 years of age: role of comorbid conditions and race.

Background: Guidelines are increasingly recommending preventive services starting at 50 years of age, and policymakers are considering such a recommendation for pneumococcal polysaccharide vaccination. The finding that pneumococcal vaccination is cost-saving for people 65 years of age or older raises the question of the vaccination's implications for other older adults, especially black people, whose disease incidence exceeds that of nonblack people, and those with high-risk conditions.

Objective: To assess the implications of vaccinating black and nonblack people 50 through 64 years of age against invasive pneumococcal disease.