title: Race/ethnicity, personal health record access, and quality of care.
abstract: OBJECTIVE
  To estimate the impact of race/ethnicity and written language preference on registration for a personal health record (PHR) that included emailing providers, viewing lab results, refilling prescriptions, and other functionalities, and the impact of PHR use on quality across racial/ethnic groups with comparable access.
  
  
  METHODS
  Retrospective observational design among 3,173,774 adults. Factors affecting registration were assessed using logistic regression, and propensity score matching techniques assessed the impact of language preference on registration and PHR use on quality of care. Difference-in-differences methods assessed the significance of between-group changes in Healthcare Effectiveness Data and Information Set (HEDIS) scores, such as glycated hemoglobin and lipid screening and control.
  
  
  RESULTS
  Race/ethnicity most strongly predicted PHR registration. After adjusting for multiple factors, Asian American, Latino American, and African American members remained 23%, 55%, and 62% less likely to register, respectively, than non-Hispanic white members. Preference for Spanish as a written language predicted poor PHR adoption. The probability of registration was 0.451 (95% CI, 0.449-0.453) for English language-preferring Latinos and 0.174 (95% CI, 0.173-0.176) for Spanish language-preferring Latinos. For non- Hispanic whites, Latinos, and African Americans using the PHR, HEDIS scores increased after PHR use by 1.3 to 12.7 percentage points, compared with differences of -1.1 to 8.1 percentage points among nonusers. All but 2 difference-in-differences between PHR users and nonusers were statistically significant.
  
  
  CONCLUSIONS
  Nonwhite race/ethnicity and Spanish language preference independently predict poor PHR adoption. PHR use is associated with higher quality healthcare, and when PHR use is equivalent across racial/ethnic groups, so is quality of care.
authors.forename: Terhilda
authors.initials: T
authors.lastname: Garrido
authors.forename: Michael
authors.initials: M
authors.lastname: Kanter
authors.affiliation: Kaiser Permanente - HITTA, 1800 Harrison St, Oakland, CA 94612. E-mail: Di.X.Meng@kp.org.
authors.forename: Di
authors.initials: D
authors.lastname: Meng
authors.forename: Marianne
authors.initials: M
authors.lastname: Turley
authors.forename: Jian
authors.initials: J
authors.lastname: Wang
authors.forename: Valerie
authors.initials: V
authors.lastname: Sue
authors.forename: Luther
authors.initials: L
authors.lastname: Scott
mesh_terms: D022126:Access to Information; D000328:Adult; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D055991:Health Records, Personal; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D044469:Racial Groups / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012959:Socioeconomic Factors; D014481:United States