Department of Health Services, Policy, and Practice; CER/PCOR Scholar, Center for Evidence Synthesis in Health; Brown University School of Public Health, Providence, RI.
Harvard T. H. Chan School of Public Health, Harvard Medical School; Harvard University, Boston, MA.
Health Serv Res. 2018 Apr;53(2):803-823. doi: 10.1111/1475-6773.12677. Epub 2017 Mar 2.
To examine trends in hospital post-acute utilization indicators and to determine whether improvement in these indicators is associated with attesting to meaningful use (MU).
Medicare claims-based, repeated measures on 30-day hospital-wide all-cause readmission and emergency department (ED) utilization rates for 160 short-stay hospitals (2009-2012); Medicare EHR Incentive Program Payments files (2011-2012); and other hospital and market data.
Interrupted time series with concurrent comparison group.
Propensity score-weighted multilevel models for change demonstrate that 30-day readmission rates (unadjusted) fell from 13.4 percent in 2009 to 12.1 percent in 2012. Similarly, 30-day ED utilization declined from 18.9 percent to 17.3 percent during the same period. However, MU and non-MU hospitals were indistinguishable vis-à-vis performance. Controlling for hospital and market characteristics, MU was unrelated to 30-day readmission. In contrast, 30-day ED utilization deteriorated.
Hospitals with MU Stage 1 designation did not show significantly higher improvement on post-acute utilization compared to their counterparts without. To achieve gains in quality and safety, potentially associated with EHRs, and to advance care coordination and patient engagement, the regulators should strengthen accountability by linking comprehensive, outcomes-based performance measures to specific MU objectives.
研究医院出院后利用指标的趋势，并确定这些指标的改善是否与达到有意义使用（MU）有关。
基于医疗保险索赔的、对 160 家短期住院医院 30 天全因再入院和急诊部（ED）利用率的重复测量（2009-2012 年）；医疗保险电子健康记录激励计划支付文件（2011-2012 年）；以及其他医院和市场数据。
具有同期对照组的中断时间序列。
变化的倾向评分加权多水平模型表明，30 天再入院率（未经调整）从 2009 年的 13.4%下降到 2012 年的 12.1%。同样，在同一时期，30 天 ED 利用率从 18.9%下降到 17.3%。然而，MU 和非 MU 医院在表现方面没有区别。在控制了医院和市场特征后，MU 与 30 天再入院无关。相比之下，30 天 ED 利用率恶化了。
具有 MU 第 1 阶段指定的医院在出院后利用方面的改善与没有 MU 医院相比并没有显著提高。为了在电子病历方面取得质量和安全方面的收益，并推进护理协调和患者参与，监管机构应通过将基于全面的、基于结果的绩效指标与特定的 MU 目标联系起来，加强问责制。
