title: Primary care capacity as insurance coverage expands: examining the role of health information technology.
abstract: OBJECTIVE
  Under the Affordable Care Act, many newly insured Americans have the challenge of establishing care with a primary care physician (PCP). We sought to examine whether health information technology (HIT) use in primary care practices was associated with anticipated capacity to accept new patients.
  
  
  METHODS
  Secondary analysis of a cross-sectional survey of Michigan PCPs from the specialties of pediatrics, internal medicine, and family medicine, conducted from October to December 2012. HIT use was considered independently for 8 types of HIT and in aggregate as a total count of HIT in use. Primary care capacity was assessed as self-reported capacity to accept new patients.
  
  
  RESULTS
  Of 739 respondents, 83% reported they anticipated capacity to accept new patients. In multivariable analysis, we found that physiians using a greater number of HITs were significantly less likely to anticipate capacity to accept new patients (adjusted odds ratio [OR] = 0.86; 95% CI, 0.76-0.97). PCPs with higher HIT use were also less likely to accept patients with private insurance (adjusted OR 0.87; 95% CI, 0.77-0.97), but not with Medicaid (adjusted OR 0.94; 95% CI, 0.84-1.05) or Medicare (adjusted OR 0.91; 95% CI, 0.83-1.01). Among individual HITs, electronic health records (adjusted OR 0.54; 95% CI, 0.30-0.96) and electronic access to admitting hospital records (adjusted OR 0.46; 95% CI, 0.22-0.96) were the only HITs significantly associated with lower anticipated primary care capacity.
  
  
  CONCLUSIONS
  PCPs using a greater number of HITs were less likely to anticipate capacity to accept new patients. Implementation of HIT and other practice innovations must be carefully coordinated to optimize capacity to care for the newly insured.
authors: Robert Wood Johnson Foundation Clinical Scholar, Clinical Lecturer in Inter- nal Medicine, University of Michigan, 2800 Plymouth Rd, Bldg 10, Rm G016, Ann Arbor, MI 48109. E-mail: rtipirne@med.umich.edu.
authors: Renuka
authors: R
authors: Tipirneni
authors: Ezinne G
authors: EG
authors: Ndukwe
authors: Melissa
authors: M
authors: Riba
authors: HwaJung
authors: H
authors: Choi
authors: Regina
authors: R
authors: Royan
authors: Danielle
authors: D
authors: Young
authors: Marianne
authors: M
authors: Udow-Phillips
authors: Matthew M
authors: MM
authors: Davis
mesh_terms: D003430:Cross-Sectional Studies; D057286:Electronic Health Records / Q000706:statistics & numerical data; D055695:Electronic Prescribing / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D008484:Medicaid / Q000706:statistics & numerical data; D008490:Medical Informatics / Q000706:statistics & numerical data*; D008824:Michigan; D058991:Patient Protection and Affordable Care Act / Q000331:legislation & jurisprudence; D058007:Physicians, Primary Care / Q000706:statistics & numerical data*; D014481:United States