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Program Feature Description Funding Seventeen communities each received approximately $11–16 million each to build and strengthen the health information technology infrastructure in each community, use health information technology to drive quality improvement, and test innovative practices. Community-level focus Of the 17 Beacon communities, 1 was urban, 7 were predominantly rural, and 7 were a mix of both urban and rural localities. Different communities defined themselves in various ways; some Beacon communities attempted to change the entire delivery system in their community, whereas others focused more narrowly. Collaborative governance To ensure that each Beacon was responsive to the needs of the community, Beacon grantees were required to engage multiple stakeholders in decision-making regarding the goals and interventions that were pursued. Partnerships within the communities were forged and strengthened during the Beacon program. Specific objectives Each community honed the objectives from their funding proposal into specific, measurable goals that could be achieved during the 2-year project period. Interventions tied to the objectives of each community Once each community winnowed their objectives down to specific, measurable goals, they received technical assistance to design and implement interventions to work toward those goals. Measuring and reporting performance Beacon communities were required to report, on a quarterly basis, performance measures of their choosing. The measures were selected to reflect improvements on the objectives of each community. Technical assistance for extracting, aggregating, and reporting the data was provided. Data feedback for quality improvement Each quarter, the Beacon communities received a feedback report that was based on analysis of Medicare claims data. The feedback report highlighted patterns in utilization and costs, and communities received technical assistance with interpreting the feedback reports and changing their approaches to pursuing their objectives based on the feedback reports. Characteristics Overall Non–Beacon Community Beacon Community Health centers Patients served annually at each health center (mean no.) 17,646.60 17,417.23 20,516.00* Rural 47.52 47.96 41.96 Region South 34.51 35.49 22.35† Northeast 17.65 17.46 20.00 Midwest 18.90 18.53 23.53‡ West 28.94 28.53 34.12 Receive funding to target services to special populations Homeless 19.59 19.81 16.86 Migrant and seasonal farm workers 13.99 13.89 15.29 Accreditation or patient-centered medical home recognition (mean %) 32.97 32.61 37.65 Patient demographics <100% FPL 68.58 68.59 68.47 Insurance status and type Uninsured 39.29 39.28 39.40 Medicaid 34.00 33.83 36.14* Other public 1.83 1.83 1.81 Private 16.11 16.21 14.86 Medicare 7.99 8.06 7.02‡ Race/ethnicity Hispanic 25.22 25.42 22.73 Black 19.66 19.43 22.44 Other race 12.33 12.35 11.98 White 42.68 42.67 42.85 Male sex 42.60 42.65 41.86 Age (years) 0–19 30.77 30.60 32.90‡ 20–64 61.42 61.51 60.28 ≥65 7.74 7.82 6.81‡ 2010 2011 2012 Health Centers (mean %) Percentage Point Difference Health Centers (mean %) Percentage Point Difference (P Value) Health Centers (mean %) Percentage Point Difference (P Value) Overall Non-Beacon Beacon Overall Non-Beacon Beacon Overall Non-Beacon Beacon Any EHR 64.82 63.97 75.29 11.32* 79.61 79.10 85.88 6.78 89.98 89.40 97.65 8.25* EHR at all sites 50.67 50.09 57.65 7.56 65.16 64.43 74.12 9.69 79.30 78.71 87.06 8.35 Basic EHR 29.74 29.38 34.12 4.74 40.34 39.98 44.71 4.73 49.75 48.52 65.88 17.36† - Table 4. Factors Associated With Gaining Basic Electronic Health Record Capability Between 2010 and 2012
Covariate Adjusted Odds Ratio (95% CI) P Value Beacon Yes 1.71 (1.31–2.24)* .00 No (reference) 1 Rural Yes 0.90 (0.74–1.09) .27 No (reference) 1 Region South (reference) 1 Northeast 1.26 (0.99–1.61) .06 Midwest 1.23 (0.98–1.54) .07 West 0.83 (0.66–1.04) .11 Size (patients served annually/1000) 1.00 (0.99–1.00) .07 Poverty (<100% FPL) 1.01 (1.00–1.01)* .00 Insurance status and type Lacking health insurance 0.99 (0.98–1.00)* .00 Covered by Medicaid 0.99 (0.98–1.00)† .01 Other types of insurance (reference) 1 Race/ethnicity Hispanic 1.00 (1.00–1.00) .91 Black 1.00 (0.99–1.00) .23 Other race 1.00 (0.99–1.00) .25 White, non-Hispanic (reference) 1 Year 2010 0.92 (0.77–1.11) .39 2011 0.95 (0.80–1.14) .61 2012 (reference) 1 Health Centers Using Each Functionality (%) Percentage Point Difference Between Beacon and Non-Beacon 2010 2012 2010 2012 Overall Non-Beacon Beacon Overall Non-Beacon Beacon Structured data capture Patient history and demographic information 63.94 63.01 75.29 89.57 88.95 97.65 12.28* 8.70* Electronic order transmission Prescriptions 50.40 49.61 60.00 86.31 85.62 95.29 10.39 9.67* Lab orders 49.96 49.33 57.65 74.46 73.85 82.35 8.32 8.50 Radiology orders 21.73 21.39 25.88 34.89 35.49 27.06 4.49 −8.43 Clinical decision support Guideline-based reminders for interventions or tests 51.11 50.19 62.35 80.05 78.89 95.29 12.16* 16.40† Prompt for and record of tobacco cessation intervention 34.91 34.10 44.71 67.20 66.49 76.47 10.61‡ 9.98 Engaging patients and families Capability to provide patients with an electronic copy of their health information upon request 41.14 40.27 51.76 70.95 70.97 70.59 11.49* −0.38 Capacity to give clinical summaries to patients after visits 52.09 51.16 63.53 85.06 84.28 95.29 12.37* 11.01‡ Care coordination and performance measurement Capability to exchange key clinical information 32.50 31.98 38.82 55.09 54.00 69.41 6.84 15.41‡ Electronically submit clinical measures 49.87 49.33 56.47 70.78 70.17 78.82 7.14 8.65 Public health Disease notifications sent electronically 11.58 11.46 12.94 18.61 18.69 17.65 1.48 −1.04 Electronic reporting to immunization registries 21.37 21.00 25.88 36.14 35.76 41.18 4.88 5.42
