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The associations between query-based and directed health information exchange with potentially avoidable use of health care services.

ABSTRACT: OBJECTIVE:To quantify the impact of two approaches (directed and query-based) to health information exchange (HIE) on potentially avoidable use of health care services. DATA SOURCES/STUDY SETTING:Data on ambulatory care providers' adoption of HIE were merged with Medicare fee-for-service claims from 2008 to 2014. Providers were from 13 counties in New York served by the Rochester Regional Health Information Organization (RHIO). STUDY DESIGN:Linear regression models with provider and year fixed effects were used to estimate changes in the probability of utilization outcomes for Medicare beneficiaries attributed to providers adopting directed and/or query-based HIE compared with beneficiaries attributed to providers who had not adopted HIE. DATA COLLECTION:Providers' HIE adoption status was determined through Rochester RHIO registration records. RHIO and claims data were linked via National Provider Identifiers. PRINCIPAL FINDINGS:Query-based HIE adoption was associated with a 0.2 percentage point reduction in the probability of an ambulatory care sensitive hospitalization and a 1.1 percentage point decrease in the likelihood of an unplanned readmission. Directed HIE adoption was not associated with any outcome. CONCLUSIONS:The Centers for Medicare & Medicaid Services' (CMS) EHR certification criteria includes requirements for directed HIE, but not query-based HIE. Pending further research, certification criteria should place equal weight on facilitating query-based and directed exchange.

SUBMITTER: Vest JR

PROVIDER: S-EPMC6736925 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

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The associations between query-based and directed health information exchange with potentially avoidable use of health care services.

Vest Joshua R JR Unruh Mark Aaron MA Shapiro Jason S JS Casalino Lawrence P LP

Health services research 20190521 5

<h4>Objective</h4>To quantify the impact of two approaches (directed and query-based) to health information exchange (HIE) on potentially avoidable use of health care services.<h4>Data sources/study setting</h4>Data on ambulatory care providers' adoption of HIE were merged with Medicare fee-for-service claims from 2008 to 2014. Providers were from 13 counties in New York served by the Rochester Regional Health Information Organization (RHIO).<h4>Study design</h4>Linear regression models with pro ...[more]

PMID: 31112303

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Project description:BackgroundThe use of the internet for health information among older people is receiving increasing attention, but how it is associated with chronic health conditions and health service use at concurrent and subsequent time points using nationally representative data is less known.ObjectiveThis study aimed to determine whether the use of the internet for health information is associated with health service utilization and whether the association is affected by specific health conditions.MethodsThe study used data collected in a technology module from a nationally representative sample of community-dwelling older Americans aged 52 years and above from the 2012 Health and Retirement Study (HRS; N=991). Negative binomial regressions were used to examine the association between use of Web-based health information and the reported health service uses in 2012 and 2014. Analyses included additional covariates adjusting for predisposing, enabling, and need factors. Interactions between the use of the internet for health information and chronic health conditions were also tested.ResultsA total of 48.0% (476/991) of Americans aged 52 years and above reported using Web-based health information. The use of Web-based health information was positively associated with the concurrent reports of doctor visits, but not over 2 years. However, an interaction of using Web-based health information with diabetes showed that users had significantly fewer doctor visits compared with nonusers with diabetes at both times.ConclusionsThe use of the internet for health information was associated with higher health service use at the concurrent time, but not at the subsequent time. The interaction between the use of the internet for health information and diabetes was significant at both time points, which suggests that health-related internet use may be associated with fewer doctor visits for certain chronic health conditions. Results provide some insight into how Web-based health information may provide an alternative health care resource for managing chronic conditions.

Project description:BackgroundPatients with co-occurring behavioral health and chronic medical conditions frequently overuse inpatient hospital services. This pattern of overuse contributes to inefficient health care spending. These patients require coordinated care to achieve optimal health outcomes. However, the poor exchange of health-related information between various clinicians renders the delivery of coordinated care challenging. Health information exchanges (HIEs) facilitate health-related information sharing and have been shown to be effective in chronic disease management; however, their effectiveness in the delivery of integrated care is less clear. It is prudent to consider new approaches to sharing both general medical and behavioral health information.ObjectiveThis study aims to identify and describe factors influencing the intention to use behavioral health information that is shared through HIEs.MethodsWe used a mixed methods design consisting of two sequential phases. A validated survey instrument was emailed to clinical and nonclinical staff in Alabama and Oklahoma. The survey captured information about the impact of predictors on the intention to use behavioral health data in clinical decision making. Follow-up interviews were conducted with a subsample of participants to elaborate on the survey results. Partial least squares structural equation modeling was used to analyze survey data. Thematic analysis was used to identify themes from the interviews.ResultsA total of 62 participants completed the survey. In total, 63% (n=39) of the participants were clinicians. Performance expectancy (β=.382; P=.01) and trust (β=.539; P<.001) predicted intention to use behavioral health information shared via HIEs. The interviewees (n=5) expressed that behavioral health information could be useful in clinical decision making. However, privacy and confidentiality concerns discourage sharing this information, which is generally missing from patient records altogether. The interviewees also stated that training for HIE use was not mandatory; the training that was provided did not focus specifically on the exchange of behavioral health information.ConclusionsDespite barriers, individuals are willing to use behavioral health information from HIEs if they believe that it will enhance job performance and if the information being transmitted is trustworthy. The findings contribute to our understanding of the role HIEs can play in delivering integrated care, particularly to vulnerable patients.

Dataset Information

The associations between query-based and directed health information exchange with potentially avoidable use of health care services.

Publications

The associations between query-based and directed health information exchange with potentially avoidable use of health care services.

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