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Medical Care Research and Review
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Physician Clinical Information Technology and Health Care Disparities

Jonathan D. Ketcham

Arizona State University, Tempe

Karen E. Lutfey

New England Research Institutes, Watertown, Massachusetts

Eric Gerstenberger

New England Research Institutes, Watertown, Massachusetts

Carol L. Link

New England Research Institutes, Watertown, Massachusetts

John B. McKinlay

New England Research Institutes, Watertown, Massachusetts

The authors develop a conceptual framework regarding how information technology (IT) can alter within-physician disparities, and they empirically test some of its implications in the context of coronary heart disease. Using a random experiment on 256 primary care physicians, the authors analyze the relationships between three IT functions (feedback and two types of clinical decision support) and five process-of-care measures. Endogeneity is addressed by eliminating unobserved patient characteristics with vignettes and by proxying for omitted physician characteristics. The results indicate that IT has no effects on physicians’ diagnostic certainty and treatment of vignette patients overall. The authors find that treatment and certainty differ by patient age, gender, and race. Consistent with the framework, IT’s effects on these disparities are complex. Feedback eliminated the gender disparities, but the relationships differed for other IT functions and process measures. Current policies to reduce disparities and increase IT adoption may be in discord.

Key Words: health disparities • clinical information technology • clinical decision making • Bayesian model • statistical discrimination

This version was published on December 1, 2009

Medical Care Research and Review, Vol. 66, No. 6, 658-681 (2009)
DOI: 10.1177/1077558709338485
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