The purpose of this study is to determine the value of shared health information on care quality and costs when this information is used to notify care providers about concerning health events for patients cared for by a community-based network of providers.
Project Abstract This three-year project will assess the costs and benefits of health information technology (HIT) in an established community-wide network of academic, private and public healthcare facilities created to share clinical information for the purpose of population-based care management of over 16,000 Medicaid beneficiaries in Durham County, North Carolina. The area of interest for this project is the impact of information-driven interventions on care quality, patient safety and healthcare costs across the diverse stakeholders participating in this collaborative partnership. In order to asses HIT value rigorously in the context of a production information system that is under continual development, we propose to conduct a randomized controlled trial. Specifically, we will randomly assign patients by family unit to either a control group or to an intervention group in which they will initially receive one of 3 information-driven interventions. The interventions include clinical alerts sent to care providers, performance feedback reports presented to clinic managers, and care reminders sent directly to patients. The content of the interventions will address "concerning" events (e.g., an emergency room encounter for asthma) and care deficiencies (e.g., delinquency on biannual mammogram) identified from the composite set of clinical data in our information system. To assess the benefits and burdens of the interventions, combinations of the 3 interventions will be sequentially introduced into the study groups over the course of the project. The analysis will compare groups receiving various combinations of interventions as well as those receiving no interventions. At baseline and at six-month intervals throughout the course of the study, we will measure emergency department encounter rates, hospitalization rates, HEDIS (Healthcare Effectiveness Data and Information Set) scores, missed appointment rates, glycated hemoglobin levels in diabetics, and patient satisfaction. Our assessment will look at the societal value of HIT as well as the value for individual stakeholders including patients, providers, payers, purchasers and policy makers. From these measures, we will assess the costs and benefits of this community-wide effort to promote interoperability of clinical data exchange in order to increase the understanding of HIT value in a community setting. In our preliminary studies, we have observed a statistically significant 3-fold reduction in repeat ED (Emergency Department) encounter rates using email alerts alone. The approach used in this project is able to be generalized across geographic areas and healthcare settings and can, therefore, serve to promote the dissemination of HIT to other communities.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
20,108
computer decision support system that generates notifications about sentinel health events and communicates this information via electronic mail to care managers, feedback reports to clinical managers, and letters to patients
Duke University Medical Center
Durham, North Carolina, United States
Emergency department utilization rates and hospitalization rates
Time frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
ED encounter rates for low severity conditions
Time frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
ED encounter rates for asthma
Time frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
ED encounter rates for diabetes
Time frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
Hospitalization rates
Time frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
Hospitalization rates for asthma (also PQI)
Time frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
Hospitalization rates for diabetes (also PQI)
Time frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
Glycemic control (hemoglobin A1c)
Time frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
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Medication contraindications
Time frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
HEDIS - Preventive services
Time frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
HEDIS - # WCC visits
Time frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
AHRQ Prevention Quality Indicators
Time frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
HEDIS - Asthma and diabetes
Time frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
# of messages triggered for health risks
Time frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
# of messages triggered for barriers to care
Time frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
Missed appointment rates
Time frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
Primary care appointment rates
Time frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
F/U rates post-partum
Time frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
Patient satisfaction instruments (CHAPS)
Time frame: at 6 to 9 months after the intervention has been introduced and then at 3 to 6-month intervals as the intervention is sequentially enhanced.
EuroQoL
Time frame: at 6 to 9 months after the intervention has been introduced and then at 3 to 6-month intervals as the intervention is sequentially enhanced.
Provider opinion surveys
Time frame: At conclusion of study
Costs of ED utilization for all causes
Time frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
Costs of ED use for asthma
Time frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
Costs of ED use for diabetes
Time frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
Costs of ED use for low severity visits
Time frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
Hospitalization costs for all causes
Time frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
Hospitalization costs for asthma
Time frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
Hospitalization costs for diabetes
Time frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
Reimbursement for labs+other ancillary services
Time frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
Primary care reimbursement
Time frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
ED rates for recurrent ED encounters
Time frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.