Showing Health Information Value in a Community Network
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 20,108
- 试验地点
- 1
- 主要终点
- Emergency department utilization rates and hospitalization rates
研究概览
简要总结
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.
详细描述
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.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Factorial
- 主要目的
- Treatment
- 盲法
- Single (Participant)
入排标准
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Enrollment in the Community Care of North Carolina Medicaid program in Durham County North Carolina
排除标准
- 未提供
研究组 & 干预措施
3
letters to patients with notifications about sentinel health events
干预措施: Computer-based clinical decision support. (Other)
6
letters to patients with notifications about sentinel health events -- generated but withheld
2
feedback reports with notifications to clinic managers about sentinel health events
干预措施: Computer-based clinical decision support. (Other)
4
electronic mail notifications to care managers about sentinel health events -- generated but withheld
5
feedback reports with notifications to clinic managers about sentinel health events -- generated but withheld
1
electronic mail notifications to care managers about sentinel health events
干预措施: Computer-based clinical decision support. (Other)
结局指标
主要结局
Emergency department utilization rates and hospitalization rates
时间窗: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
次要结局
- ED encounter rates for low severity conditions(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(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(at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.)
- Hospitalization rates(at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.)
- HEDIS - Preventive services(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)(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)(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)(at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.)
- Medication contraindications(at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.)
- HEDIS - # WCC visits(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(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(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(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(at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.)
- Provider opinion surveys(At conclusion of study)
- Patient satisfaction instruments (CHAPS)(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(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.)
- Missed appointment rates(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(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(at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.)
- Costs of ED utilization for all causes(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(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(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(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(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(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(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(at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.)
- Primary care reimbursement(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(at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.)