Performance Improvement 2003. Center for Primary Care Research


Assessing the Information Technology Infrastructure in Integrated Delivery Systems

There is evidence of increased investment in information technology (IT) by the health care industry, but little is known about how integrated delivery systems (IDSs) acquire, implement, use, and evaluate IT. How extensive is the use of IT in IDSs, and what capabilities do IDSs have to integrate data from different IT system components? How are the special needs of vulnerable populations addressed using IT systems? To address these questions and others, the Agency for Healthcare Research and Quality funded the University of North Carolina’s IDS Research Network. Information was obtained about the IT infrastructures of the six IDSs in the RTI-UNC IDSRN through a replicated series of in-depth case studies that involved a series of six two-day site visits. The study found that decisions to adopt, and subsequent implementation of, these systems in IDS settings are extremely complex processes. The financial investment and cultural implications for implementing this type of innovative clinical process are different from those typically encountered with traditional IT systems developed for billing or registration  purposes. Key observations from the analysis of case study data suggest that: (1) with experience, IDSs moved toward centralized decision making, (2) IDSs took a phased approach to implementation that involved sequential installation of IT systems across care delivery sites and maintenance of parallel data entry, storage, and retrieval systems, and (3) there was a necessity for organizational infrastructure (i.e., sufficient staffing, dedicated IT department) to support implementation and maintenance of IT solutions.

FEDERAL CONTACT: Kelly Morgan, 301-427-1570

PIC ID: 7674

PERFORMER: Research Triangle Institute, Research Triangle Park, NC


Evaluating AHRQ’s Low-Income Research Portfolio, 1989-2000: Final Report

The purpose of this report was to provide an understanding of the breadth and depth of AHRQ’s low- income populations research portfolio and to identify potential directions for continued research in this area for the next decade. This report was the final deliverable for a project representing the first phase in low-phase evaluation of AHRQ’s low-income research portfolio. This phase of the evaluation answered the following two questions: (1) what contributions has AHRQ’s sponsored research made to knowledge about health care for low-income populations and (2) comparing AHRQ’s research portfolio to the body of literature in the field, in what areas has the agency made the greatest contributions and in what areas have agency investments been low? This report presented findings from the first phase of the evaluation. Studies of access to prenatal and obstetric care found that it is possible to improve provider participation in obstetrics for Medicaid patients with a comprehensive Medicaid expansion program. Also, low income is associated with significantly elevated risks of untimely prenatal care, but the increased risk of untimely care is not confined to women in absolute poverty or to those lacking private insurance. Studies that focused on pregnancy outcomes found that density of obstetricians appeared to have no impact on pregnancy outcomes. Also, heightened levels of stress were not associated with earlier deliveries. Studies focused on prenatal quality of care found that patients’ ideas of what constitutes quality in prenatal care did not appear to differ by ethnicity. In another study, satisfaction also did not appear to vary according to personal characteristics.

FEDERAL CONTACT: Robin Weinick, 301-427-1573 PIC ID: 7687

PERFORMER: Center for Health Policy Studies, Columbia, MD

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