BOSTON MEDICAL CENTER CORPORATION

To develop an extensive, de-identified, easily accessible database including information about child and adult residents using clinical data from: (1) New England's largest safety net hospital, Boston Medical Center, and its affiliated community health centers; (2) another large academic tertiary care system, University of Massachusetts Medical Center in central MA whose patient population is more white and middle class; and (3) claims data from the BMC Health Plan, the largest statewide provider of the new insurance product for low income individuals. We will use i2b2, an open-source, scalable informatics platform offering a broad array of translational informatics tools including a clinical data repository and a standard ontology. I2b2's data structure, ontology, and query (analytic) tools allow the integration and analysis of massive amounts of de-identified data from disparate systems, and presents a radical advance in the ability to use clincial data for disparitites monitoring. Furthermore, all i2b2 systems share a common architecture; data, queries, and software tools can be shared between systems to support inter-institutional disparities research. We will test the feasibility of applying this novel resource for disparities monitoring for common CVD risk factors and chronic conditions which lead to substantial morbidity and mortality, where there are known disparities, and which the national public health goals of HP2010 seek to improve: hypertension, hperlipidemia, obesity/overweight, and tobacco use. We have three primary aims: (1) develop a powerful infrastructure to monitor CVD risk factors and outcomes. Using i2b2, we will create a large, longitudinal, statewide de-identified database, and develop new software tools and resources to monitor and analyze pediatric and adult health disparities; (2) Explore the effects of health reform and the economic downturn on disparities in health outcomes. We will examine changes in health insurance coverage and health disparities during pre and post reform periods, and periods before and into the current economic downturn; (3) develop strategies for sharing tools and communicating results to policy makers, health care providers, and the research community.

Clarification of Codes