Paso del Norte Health Information Exchange, El Paso, Texas
Department of Public Health, Brigham Young University, Provo, Utah.
Ann Fam Med. 2023 Jan-Feb;21(1):19-26. doi: 10.1370/afm.2903.
Few studies have determined whether clinician usage of a community health information exchange (HIE) directly improves patient care transitions. We hypothesized that lookup in the HIE by primary care physicians of patients recently released from the hospital would increase the time until hospital reuse.
We identified a retrospective cohort of 8,216 hospital inpatients aged over 18 years that were discharged from January 1, 2021 through November 30, 2021 using the Paso del Norte Health Information Exchange, in El Paso County, Texas. All patients had a primary care physician visit within 30 days after hospital discharge, and we identified patients that were looked up in the HIE close to that visit. Of the cohort, 2,627 were rehospitalized and 3,809 visited an emergency department (ED) during the follow-up window. The remaining 1,780 patients were controls. We conducted survival analysis, censoring at the second ED or inpatient visit or end of the study window (January 31, 2022). The model was adjusted by ethnicity, gender, insurance, and age.
Lookup in the HIE was significantly associated with reducing the likelihood of visiting the ED by 53% and being rehospitalized by 61%. Lookup in the HIE was associated with an increased median time to use of the ED after inpatient discharge from 99 to 238 patient days. Ethnicity, insurance, gender, and age were also significant predictors of hospital reuse.
Increased utilization of community HIEs by primary care physicians on behalf of their recently discharged patients may dramatically increase the time until inpatient or ED reuse.
很少有研究确定临床医生使用社区健康信息交换（HIE）是否直接改善患者的护理过渡。我们假设，初级保健医生在患者出院后不久通过 HIE 查找患者的信息，会增加医院再次使用的时间。
我们使用德克萨斯州埃尔帕索县的 Paso del Norte 健康信息交换系统，确定了 2021 年 1 月 1 日至 2021 年 11 月 30 日期间出院的 8216 名 18 岁以上住院患者的回顾性队列。所有患者在出院后 30 天内都有一次初级保健医生就诊，我们确定了在就诊附近通过 HIE 查找的患者。在队列中，有 2627 人再次住院，3809 人在随访期间到急诊部（ED）就诊。其余 1780 名患者为对照组。我们进行了生存分析，以第二次 ED 就诊或住院就诊或研究窗口结束（2022 年 1 月 31 日）为截止点。该模型通过种族、性别、保险和年龄进行了调整。
通过 HIE 进行查找与 ED 就诊的可能性降低 53%和再次住院的可能性降低 61%显著相关。通过 HIE 进行查找与住院后使用 ED 的中位时间从 99 天增加到 238 天有关。种族、保险、性别和年龄也是医院再次使用的重要预测因素。
代表最近出院的患者增加社区 HIE 的使用，可能会显著增加住院或 ED 再次使用的时间。
