Hospitalization event notifications and reductions in readmissions of Medicare fee-for-service beneficiaries in the Bronx, New York

Abstract

Alerting providers through event notifications may be an effective tool for improving the quality and efficiency of care among high-risk populations.

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

“…This study presents stronger evidence of ambulatory care providers' adoption of query-based HIE reducing avoidable utilization. Contrary to expectations based on prior research,23,54 directed HIE adoption was not associated with reductions in potentially avoidable utilization. This study was the first to contrast the impact of query-based and directed HIE in the ambulatory care setting on potentially avoidable utilization, contributes to the growing and more rigorous evidence base of HIE, and highlights the current limitations of US HIE policy.The moderate negative association between query-based exchange adoption and ACSHs and unplanned readmissions is consistent with positive benefits from HIE reported in the literature 27.…”

“…The absence of a relationship between directed exchange and readmissions in this study was unexpected. Prior studies based on strong research designs have identified specific directed exchange tools as a beneficial intervention to reduce readmissions in select populations . This discrepancy with previous research may be attributable to our study's focus on unplanned readmissions, ACSHs, and nonemergent ED visits.…”

“…Prior studies based on strong research designs have identified specific directed exchange tools as a beneficial intervention to reduce readmissions in select populations. 23,54 This discrepancy with previous research may be attributable to our study's focus on unplanned readmissions, ACSHs, and nonemergent ED visits. Directed exchange may "inundate" providers with information, making it difficult to find the relevant details.…”

“…The most consistent evidence in support of HIE as a stand‐alone intervention to positively affect health care delivery comes largely from emergency department settings and from studies of specific use cases, such as provider use of repeat and/or appropriate imaging, medication reconciliation, or prescribing behavior . In contrast, studies in ambulatory care settings have been less consistent, ranging from no impact, to mixed results, to some observed improvements in outcomes for specific patient populations . Absence of strong evidence of its effectiveness has been a barrier to broader HIE adoption …”

“…18,19 In contrast, studies in ambulatory care settings have been less consistent, ranging from no impact, 20 to mixed results, 21,22 to some observed improvements in outcomes for specific patient populations. 23,24 Absence of strong evidence of its effectiveness has been a barrier to broader HIE adoption. 25 In addition, the existing evidence base of the impact of HIE does not adequately distinguish between different technological approaches to HIE.…”