Abstract
BackgroundCoordination 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.MethodsIn 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.DiscussionWhile 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 registrationClinicalTrials.gov NCT02689076. “Regional Data Exchange to Improve Care for Veterans After Non-VA Hospitalization.” Registered 23 February 2016.
Highlights
Coordination of care, especially after a patient experiences an acute care event, is a challenge for many health systems
Using a semi-automated method in which we identify potentially eligible veterans using electronic health record (EHR) data in combination with the scheduling system similar to prior Veterans Health Administration (VHA) studies [32], we will send letters to veterans with upcoming Veterans Affairs (VA) primary care appointments whose medical chart pass initial screening
Our study is innovative in its use of a trial design to examine the impact of event notifications, enabled by Health information exchange (HIE), on health outcomes
Summary
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. 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. Delivering high quality, coordinated care requires that providers access, manage, and share information efficiently. Managing a patient’s health information for care coordination activities, is challenging. Respondents from Australia, Canada, France, and other nations indicated similar information gaps with respect to care coordination [5]
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