Regional data exchange to improve care for veterans after non-VA hospitalization: a randomized controlled trial

Abstract

Background Coordination of care, especially after a patient experiences an acute care event, is a challenge for many health systems. Event notification is a form of health information exchange (HIE) which has the potential to support care coordination by alerting primary care providers when a patient experiences an acute care event. While promising, there exists little evidence on the impact of event notification in support of reengagement into primary care. The objectives of this study are to 1) examine the effectiveness of event notification on health outcomes for older adults who experience acute care events, and 2) compare approaches to how providers respond to event notifications. Methods In a cluster randomized trial conducted across two medical centers within the U.S. Veterans Health Administration (VHA) system, we plan to enroll older patients (≥ 65 years of age) who utilize both VHA and non-VHA providers. Patients will be enrolled into one of three arms: 1) usual care; 2) event notifications only; or 3) event notifications plus a care transitions intervention. In the event notification arms, following a non-VHA acute care encounter, an HIE-based intervention will send an event notification to VHA providers. Patients in the event notification plus care transitions arm will also receive 30 days of care transition support from a social worker. The primary outcome measure is 90-day readmission rate. Secondary outcomes will be high risk medication discrepancies as well as care transitions processes within the VHA health system. Qualitative assessments of the intervention will inform VHA system-wide implementation. Discussion While HIE has been evaluated in other contexts, little evidence exists on HIE-enabled event notification interventions. Furthermore, this trial offers the opportunity to examine the use of event notifications that trigger a care transitions intervention to further support coordination of care. Trial registration ClinicalTrials.gov NCT02689076. “Regional Data Exchange to Improve Care for Veterans After Non-VA Hospitalization.” Registered 23 February 2016.

Utilizing a health information exchange to facilitate COVID-19 VA primary care follow-up for Veterans diagnosed in the community

“…Health information exchange is defined as the electronic transfer of clinical, administrative, or other information necessary for the delivery of health care across diverse systems or organizations. 4 , 5 …”

Characteristics of Veterans With Non-VA Encounters Enrolled in a Trial of Standards-Based, Interoperable Event Notification and Care Coordination

“…4,17 Since it is anticipated that non-VHA care visits will increase, it is incumbent on the VHA to strengthen care coordination processes to control quality of care as well as costs. 12 This study has several limitations. First, this cohort consisted of veterans who volunteered for a prospective trial aimed at improving care coordination.…”

“…This study is part of a larger trial that examines the impact of VA provider notification and care coordination when older veterans use non-VA inpatient or emergency department (ED) services, described in detail elsewhere. 12…”

Reasons Older Veterans Use the Veterans Health Administration and Non-VHA Care in an Urban Environment

“…Researchers analyzed responses to a baseline survey from an ongoing coach-delivered care transitions trial, which leverages Health Information Exchange to enhance care coordination and transitions. 20 The study population included veterans who were over 65 years of age, enrolled and assigned a primary care provider at the James J Peters VA Medical Center (Bronx VAMC) in the Bronx, NY, and have previously used non-VHA services in the Bronx in the prior 2 years. Non-VHA utilization was identified within the Bronx Region Health Information Organization, a health information exchange that contains health care information from the major health systems in the Bronx designed to facilitate care coordination and patient safety.…”