Division of Clinical Informatics and Digital Transformation, Department of Medicine, University of California, San Francisco, San Francisco, CA 94131, United States.
Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA 94110, United States.
J Am Med Inform Assoc. 2023 Dec 22;31(1):15-23. doi: 10.1093/jamia/ocad204.
To use more precise measures of which hospitals are electronically connected to determine whether health information exchange (HIE) is associated with lower emergency department (ED)-related utilization.
We combined 2018 Medicare fee-for-service claims to identify beneficiaries with 2 ED encounters within 30 days, and Definitive Healthcare and AHA IT Supplement data to identify hospital participation in HIE networks (HIOs and EHR vendor networks). We determined whether the 2 encounters for the same beneficiary occurred at: the same organization, different organizations connected by HIE, or different organizations not connected by HIE. Outcomes were: (1) whether any repeat imaging occurred during the second ED visit; (2) for beneficiaries with a treat-and-release ED visit followed by a second ED visit, whether they were admitted to the hospital after the second visit; (3) for beneficiaries discharged from the hospital followed by an ED visit, whether they were admitted to the hospital.
In adjusted mixed effects models, for all outcomes, beneficiaries returning to the same organization had significantly lower utilization compared to those going to different organizations. Comparing only those going to different organizations, HIE was not associated with lower levels of repeat imaging. HIE was associated with lower likelihood of hospital admission following a treat-and-release ED visit (1.83 percentage points [-3.44 to -0.21]) but higher likelihood of admission following hospital discharge (2.78 percentage points [0.48-5.08]).
Lower utilization for beneficiaries returning to the same organization could reflect better access to information or other factors such as aligned incentives.
HIE is not consistently associated with utilization outcomes reflecting more coordinated care in the ED setting.
使用更精确的方法来衡量医院的电子化连接程度，以确定健康信息交换（HIE）是否与降低急诊部门（ED）相关利用率有关。
我们结合了 2018 年 Medicare 按服务收费的索赔数据，以确定在 30 天内有 2 次 ED 就诊的受益人的身份，并结合 Definitive Healthcare 和 AHA IT 补充数据，以确定医院参与 HIE 网络（HIO 和 EHR 供应商网络）的情况。我们确定同一受益人的 2 次就诊是否发生在：同一机构，通过 HIE 连接的不同机构，或未通过 HIE 连接的不同机构。结果为：（1）在第二次 ED 就诊期间是否有任何重复影像检查；（2）对于首次 ED 就诊后接受治疗并出院，然后再次就诊的受益人的情况，他们在第二次就诊后是否住院；（3）对于从医院出院后再次就诊的受益人的情况，他们在第二次就诊后是否住院。
在调整后的混合效应模型中，对于所有结果，与前往不同机构就诊的患者相比，返回同一机构的患者利用率显著降低。仅比较前往不同机构就诊的患者，HIE 与重复影像检查次数减少无关。HIE 与治疗后出院后再次就诊的住院可能性降低相关（1.83 个百分点[-3.44 至-0.21]），但与出院后再次就诊的住院可能性增加相关（2.78 个百分点[0.48-5.08]）。
返回同一机构的患者利用率降低可能反映了更好的信息获取或其他因素，如激励机制的一致性。
HIE 与 ED 环境中更协调的护理相关的利用率结果不一致。
