Effect of Health Information Exchange Plus a Care Transitions Intervention on Post-Hospital Outcomes Among VA Primary Care Patients: a Randomized Clinical Trial.

Autor: Boockvar KS; James J. Peters VA Medical Center, Geriatrics Research Education & Clinical Center, Bronx, NY, 10468, USA. Kenneth.boockvar@mssm.edu.; Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA. Kenneth.boockvar@mssm.edu.; The New Jewish Home, New York, NY, USA. Kenneth.boockvar@mssm.edu., Koufacos NS; James J. Peters VA Medical Center, Geriatrics Research Education & Clinical Center, Bronx, NY, 10468, USA., May J; Richard L. Roudebush VA Medical Center, Center for Health Information and Communication, Indianapolis, IN, USA., Schwartzkopf AL; Richard L. Roudebush VA Medical Center, Center for Health Information and Communication, Indianapolis, IN, USA., Guerrero VM; James J. Peters VA Medical Center, Geriatrics Research Education & Clinical Center, Bronx, NY, 10468, USA., Judon KM; James J. Peters VA Medical Center, Geriatrics Research Education & Clinical Center, Bronx, NY, 10468, USA., Schubert CC; Richard L. Roudebush VA Medical Center, Center for Health Information and Communication, Indianapolis, IN, USA.; Indiana University School of Medicine, Indianapolis, IN, USA., Franzosa E; James J. Peters VA Medical Center, Geriatrics Research Education & Clinical Center, Bronx, NY, 10468, USA.; Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Dixon BE; Richard L. Roudebush VA Medical Center, Center for Health Information and Communication, Indianapolis, IN, USA.; Department of Epidemiology, Indiana University Fairbanks School of Public Health, Indianapolis, IN, USA.; Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA.
Jazyk: angličtina
Zdroj: Journal of general internal medicine [J Gen Intern Med] 2022 Dec; Vol. 37 (16), pp. 4054-4061. Date of Electronic Publication: 2022 Feb 23.
DOI: 10.1007/s11606-022-07397-5
Abstrakt: Background: Health information exchange (HIE) notifications when patients experience cross-system acute care encounters offer an opportunity to provide timely transitions interventions to improve care across systems.
Objective: To compare HIE notification followed by a post-hospital care transitions intervention (CTI) with HIE notification alone.
Design: Cluster-randomized controlled trial with group assignment by primary care team.
Patients: Veterans 65 or older who received primary care at 2 VA facilities who consented to HIE and had a non-VA hospital admission or emergency department visit between 2016 and 2019.
Interventions: For all subjects, real-time HIE notification of the non-VA acute care encounter was sent to the VA primary care provider. Subjects assigned to HIE plus CTI received home visits and telephone calls from a VA social worker for 30 days after arrival home, focused on patient activation, medication and condition knowledge, patient-centered record-keeping, and follow-up.
Measures: Primary outcome: 90-day hospital admission or readmission.
Secondary Outcomes: emergency department visits, timely VA primary care team telephone and in-person follow-up, patients' understanding of their condition(s) and medication(s) using the Care Transitions Measure, and high-risk medication discrepancies.
Key Results: A total of 347 non-VA acute care encounters were included and assigned: 159 to HIE plus CTI and 188 to HIE alone. Veterans were 76.9 years old on average, 98.5% male, 67.8% White, 17.1% Black, and 15.1% other (including Hispanic). There was no difference in 90-day hospital admission or readmission between the HIE-plus-CTI and HIE-alone groups (25.8% vs. 20.2%, respectively; risk diff 5.6%; 95% CI - 3.3 to 14.5%, p = .25). There was also no difference in secondary outcomes.
Conclusions: A care transitions intervention did not improve outcomes for veterans after a non-VA acute care encounter, as compared with HIE notification alone. Additional research is warranted to identify transitions services across systems that are implementable and could improve outcomes.
(© 2022. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.)
Databáze: MEDLINE
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