Health Information Technology Adoption Among Health Centers: A Digital Divide in the Making?

This background paper describes the current status of efforts to implement health information technology in community health centers. It summarizes the benefits experienced by health centers that have pioneered the use of information technology and examines the challenges that have hindered wider adoption. The paper identifies a range of policy options that have been considered to promote broader use of information technology by health centers

Lessons from the Health Care Innovation Awards: Productively Engaging Vulnerable Populations to Address Social Determinants of Health

Objectives: This paper examines productive interactions—a cornerstone of the Chronic Care Model—between health care providers and vulnerable populations with chronic illnesses and/or disabilities. Methods: We conducted qualitative analysis of 16 focus groups and 29 interviews with patients and/or caregivers and 195 interviews with program leadership and providers across 15 Health Care Innovation Awards that targeted vulnerable populations. We analyzed how awardees addressed health concerns and social determinants of health (SDOH), and identified key components of productive interactions. Results: Providers achieved productive interactions through four primary strategies: establishing trust and showing respect; solving problems; building accuracy in health information exchange; and sharing accountability and responsibility. While providers sought cooperation from patients and caregivers for medical goals, they often addressed SDOH priorities. Discussion: Strategies tailored to vulnerable populations can enable shared decision-making and effective self-care. A nonjudgmental engagement style, accurate information, and consistent communication are important for patient engagement

The economic impact of Staphylococcus aureus infection in New York City hospitals.

We modeled estimates of the incidence, deaths, and direct medical costs of Staphylococcus aureus infections in hospitalized patients in the New York City metropolitan area in 1995 by using hospital discharge data collected by the New York State Department of Health and standard sources for the costs of health care. We also examined the relative impact of methicillin-resistant versus -sensitive strains of S. aureus and of community-acquired versus nosocomial infections. S. aureus-associated hospitalizations resulted in approximately twice the length of stay, deaths, and medical costs of typical hospitalizations; methicillin-resistant and -sensitive infections had similar direct medical costs, but resistant infections caused more deaths (21% versus 8%). Community-acquired and nosocomial infections had similar death rates, but community-acquired infections appeared to have increased direct medical costs per patient ($35,300 versus$28,800). The results of our study indicate that reducing the incidence of methicillin-resistant and -sensitive nosocomial infections would reduce the societal costs of S. aureus infection