Health Information Exchange to Improve Outcomes in Complex Older Patients

健康信息交换可改善复杂老年患者的治疗结果

基本信息

批准号：
10092887
负责人：
JULIA Rose ADLER-MILSTEIN
金额：
$ 41.24万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-04-01 至 2024-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10092887
关键词：
Adoption Ambulatory Care Caring Characteristics Chronic Clinical Complex Continuity of Patient Care Coupled Custom Data Data Sources Dementia Effectiveness Elderly Electronic Health Record Ensure Geography Goals Health Health Information System Health Personnel Health Status Health system Healthcare Systems Hospitalization Hospitals Iatrogenesis Image Individual Information Networks Institution Investments Link Measures Medicare Medicare claim Modeling Older Population Outcome Ownership Patient-Focused Outcomes Patients Policies Population Process Provider Quality of Care Reporting Risk Services Source Surveys System Telefacsimile Telephone Testing Time Vendor Work base beneficiary care delivery care fragmentation care providers combat cost data sharing experience health care delivery health care service organization hospital readmission improved improved outcome mortality multiple chronic conditions older patient patient health information patient population payment synergism

项目摘要

Project Summary Abstract Due to our fragmented healthcare delivery system, sharing patient health information across healthcare delivery organizations is an essential component of high-quality care but does not occur routinely. When critical health information is missing, care continuity is impeded, with increased risk of poor patient outcomes. Older adults have a disproportionate share of complex health conditions that result in their needing to see multiple providers in different organizations. They are therefore at disproportionate risk of poor outcomes that result from lack of information sharing, including repeated testing and avoidable hospitalization. To improve information sharing across healthcare delivery organizations, there has been a substantial effort over the past eight years to promote adoption of electronic health records and the ability to share patient data between them (“health information exchange” or HIE). However, there is surprisingly little evidence about whether HIE is occurring in ways that will benefit older adults, both in terms of ensuring that the healthcare organizations that treat the same patient populations are able to engage in HIE with each other and, when they are, that they use HIE in ways that improve clinical outcomes (e.g., reduce repeat testing and hospitalization). Our project will provide a national picture of the extent to which healthcare delivery organizations that routinely treat the same older patients are able to share patient information electronically with each other. Today, no such measures exist, creating a problematic blindspot in terms of understanding whether there is connectivity where it is most needed. In addition, where healthcare delivery organizations are engaging in sharing patient information electronically, we will assess whether it is improving key outcomes for the older patients that receive care from those organizations. These outcomes include repeat testing, hospitalization and rehospitalization, and mortality. Importantly, we will assess whether the benefits from electronic information sharing disproportionately accrue to two populations of patients who are most at risk of poor outcomes from lack of information sharing: those with dementia and those with multiple health conditions. By focusing on these populations, we will be able to determine whether the current “one-size-fits-all” approach to electronic health information sharing is working or whether it requires customization to the unique needs of different patient populations. By generating new evidence on the current state of electronic health information sharing across healthcare delivery organizations, study results will guide key stakeholders on how to combat the risks of care fragmentation by sharing information in ways that improve outcomes for older adults in general, and for the most vulnerable older adults in particular.

项目概要摘要由于我们分散的医疗保健服务系统，在整个医疗保健服务中共享患者健康信息组织是高质量护理的重要组成部分，但在健康状况危急时并不经常发生。信息缺失，护理连续性受到阻碍，老年人预后不良的风险增加。患有复杂健康状况的人比例过高，导致他们需要看多个医疗服务提供者因此，他们因缺乏能力而面临不成比例的不良结果风险。信息共享，包括重复检测和可避免的住院治疗改善信息共享。在过去的八年中，各个医疗保健提供组织做出了巨大的努力来促进采用电子健康记录以及在它们之间共享患者数据的能力（“健康信息然而，令人惊讶的是，很少有证据表明 HIE 是否会以这种方式发生。使老年人受益，无论是在确保治疗同一患者的医疗机构方面人们能够相互参与 HIE，并且当他们这样做时，他们会以改善 HIE 的方式使用 HIE 临床结果（例如，减少重复检测和住院治疗）。我们的项目将提供一个全国性的概况，显示医疗保健提供组织在多大程度上定期执行治疗相同的老年患者能够以电子方式彼此共享患者信息，但如今却没有这样的情况。措施的存在，在了解是否存在连通性方面造成了一个有问题的盲点此外，医疗保健提供机构参与共享患者的情况也是最需要的。电子信息，我们将评估它是否正在改善接受治疗的老年患者的关键结果这些结果包括重复检测、住院和再住院，以及重要的是，我们将评估电子信息共享带来的好处是否不成比例。由于缺乏信息共享，两类患者最容易出现不良结果：通过关注这些人群，我们将能够帮助患有痴呆症的人和患有多种健康问题的人。确定当前电子健康信息共享的“一刀切”方法是否有效或者是否需要根据不同患者群体的独特需求进行定制。通过生成有关整个医疗保健领域电子健康信息共享现状的新证据交付组织，研究结果将指导主要利益相关者如何应对护理分散的风险通过以改善一般老年人和最弱势群体的结果的方式分享信息尤其是老年人。