Health Information Exchange Improves Identification Of Frequent Emergency Department Users

Shapiro, Jason S.; Johnson, Sarah A.; Angiollilo, John; Fleischman, William; Onyile, Arit; Kuperman, Gilad J.

doi:10.1377/hlthaff.2013.0167

Cited by 40 publications

(33 citation statements)

References 50 publications

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“…This study and previous work 53,54 confirm that integrating data across health care systems provides novel insights about population-level, as opposed to simply site-specific, health care utilization patterns.…”

Section: Discussionsupporting

confidence: 78%

San Francisco Children Living In Redeveloped Public Housing Used Acute Services Less Than Children In Older Public Housing

et al. 2014

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Understanding the links between housing and health is increasingly important. Poor housing quality is a predictor of poor health and developmental problems in low-income children. We examined associations between public housing type and recurrent pediatric emergency and urgent care hospital visits. Children ages 0-18 with public insurance who sought emergency care from any of three large medical systems in San Francisco were categorized by whether they lived in public housing redeveloped through the federal HOPE VI program, nonredeveloped public housing, or nonpublic housing in a census tract that also contained public housing. After we adjusted for potential confounding characteristics, we found that children living in nonredeveloped public housing were 39 percent more likely to have one or more repeat visits within one year for acute health care services unrelated to the initial visit, compared to children who lived in redeveloped HOPE VI housing. We observed no differences in repeat visits between children in redeveloped HOPE VI housing and those in nonpublic housing. These findings support the continued redevelopment of public housing as a means of both improving the health of vulnerable high-risk children from low-income neighborhoods and reducing health care costs.

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Section: Discussionsupporting

confidence: 78%

San Francisco Children Living In Redeveloped Public Housing Used Acute Services Less Than Children In Older Public Housing

et al. 2014

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“…30 State and federal programs have increasingly looked to HIE networks to improve communication between unaffiliated providers. 17 This is important for frequent ED users with epilepsy because data collected from a single medical center may notably underestimate ED use, 14 and people with epilepsy often visit multiple centers. 15 Our work demonstrates that data collected by HIE networks can support accurate predictions.…”

Section: One-variable Model a One-variable Logistic Regression Modelmentioning

confidence: 99%

“…Studying frequent ED use is challenging, in part because people often use multiple EDs for care. 14,15 Health information exchange (HIE) networks allow users to view medical information in the electronic health records of multiple unaffiliated institutions, creating a more complete record than possible from a single center's data. 14 These technologies are increasingly available, 16,17 and may provide a data source to describe and predict frequent ED use.…”

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confidence: 99%

Predicting frequent ED use by people with epilepsy with health information exchange data

et al. 2015

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Objectives: To describe (1) the predictability of frequent emergency department (ED) use (a marker of inadequate disease control and/or poor access to care), and (2) the demographics, comorbidities, and use of health services of frequent ED users, among people with epilepsy. Methods:We obtained demographics, comorbidities, and 2 years of encounter data for 8,041people with epilepsy from a health information exchange in New York City. Using a retrospective cohort design, we explored bivariate relationships between baseline characteristics (year 1) and subsequent frequent ED use (year 2). We then built, evaluated, and compared predictive models to identify frequent ED users ($4 visits year 2), using multiple techniques (logistic regression, lasso, elastic net, CART [classification and regression trees], Random Forests, AdaBoost, support vector machines). We selected a final model based on performance and simplicity.Results: People with epilepsy who, in year 1, were adults (rather than children or seniors), male, Manhattan residents, frequent users of health services, users of multiple health systems, or had medical, neurologic, or psychiatric comorbidities, were more likely to frequently use the ED in year 2. Predictive techniques identified frequent ED visitors with good positive predictive value (approximately 70%) but poor sensitivity (approximately 20%). A simple strategy, selecting individuals with 111 ED visits in year 1, performed as well as more sophisticated models. Epilepsy is an ambulatory care sensitive condition; that is, high quality outpatient care may reduce unnecessary inpatient and emergency department (ED) care. Conclusions:1-5 Thus, frequent ED use is a "health services marker," indicating inadequate disease control and/or poor access to care. 6 Health care organizations in the United States, encouraged by recent state and federal policy changes, frequently hire care managers to coordinate care for people with ambulatory care sensitive conditions such as epilepsy.7-9 One common strategy is to focus on patients at high risk of frequent ED use.10 For people with epilepsy, several factors are associated with frequent ED use: low socioeconomic status, more seizures, anxiety, poor knowledge of epilepsy by self or caregivers, and greater stigma.11-13 However, the predictability of frequent ED use is understudied. Studying frequent ED use is challenging, in part because people often use multiple EDs for care.14,15 Health information exchange (HIE) networks allow users to view medical information in the electronic health records of multiple unaffiliated institutions, creating a more complete record than possible from a single center's data.14 These technologies are increasingly available, 16,17 and may provide a data source to describe and predict frequent ED use.From the

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“…Canadian survey data from 2006-2014 demonstrate that in six provinces the Canadian iEHR is perceived to have positive outcomes in terms of user satisfaction, impact on quality of care, and impact on productivity [15]. [1] In the ED setting in other jurisdictions, these type of read-only iEHR's have been shown to be valued by physicians [2][22], and to increase the ability to identify frequent ED users [23]. Usage of iEHR's has been reported to vary across different practice settings even when the technical configuration is identical [24], potentially resulting in inconsistent and poorly understood clinical impacts [25].…”

Section: Discussionmentioning

confidence: 99%

Emergency physician use and perceptions of the Alberta Netcare Portal, a province-wide interoperable electronic health record (Preprint)

Graham¹,

Ballermann²,

Lang³

et al. 2018

Preprint

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Health Information Exchange Improves Identification Of Frequent Emergency Department Users

Cited by 40 publications

References 50 publications

San Francisco Children Living In Redeveloped Public Housing Used Acute Services Less Than Children In Older Public Housing

San Francisco Children Living In Redeveloped Public Housing Used Acute Services Less Than Children In Older Public Housing

Predicting frequent ED use by people with epilepsy with health information exchange data

Emergency physician use and perceptions of the Alberta Netcare Portal, a province-wide interoperable electronic health record (Preprint)

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