The financial impact of health information exchange on emergency department care.
The financial impact of health information exchange on emergency department care.
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DOI：
10.1136/amiajnl-2011-000394
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发表时间：
2012-05
期刊：
影响因子：
--
通讯作者：
Chen Q
中科院分区：
文献类型：
--
作者：
Frisse ME;Johnson KB;Nian H;Davison CL;Gadd CS;Unertl KM;Turri PA;Chen Q
探讨急诊科医疗信息交换（HIE）的财务影响。我们研究了13个月期间所有急诊科的急诊病例，在此期间，我们访问了田纳西州孟菲斯市所有主要急诊科的HIE数据。将HIE访问遇到记录与没有HIE访问的类似遇到记录进行匹配。研究结果包括因ed入院、入院观察、实验室检查、头部CT、全身CT、踝关节x线片、胸部x线片和超声心动图。我们的估计采用了对入院类型、住院时间和Charlson合并症指数进行调整的逻辑回归模型的广义估计方程。边际概率用于计算结果变量的变化及其财务后果。在研究的12个急诊科中，约有6.8%的急诊科访问了HIE数据。在11个仅通过安全Web浏览器直接访问HIE数据的急诊科中，访问与住院率降低相关(调整优势比(OR)=0.27；p < 0001)。在更多依赖打印摘要的第12个ED中，HIE访问与住院率的降低相关（OR=0.48; p<0001），并且头部CT使用、身体CT使用和实验室检查订购的减少具有统计学意义。仅应用于研究人群，获得HIE与每年节省190万美元的成本相关。净年度运营成本后，HIE接入减少了107万美元的总成本。住院费用减少占总费用减少的97.6%。在急诊科环境中通过HIE获得额外的临床数据与社会净节约有关。
To examine the financial impact health information exchange (HIE) in emergency departments (EDs). We studied all ED encounters over a 13-month period in which HIE data were accessed in all major emergency departments Memphis, Tennessee. HIE access encounter records were matched with similar encounter records without HIE access. Outcomes studied were ED-originated hospital admissions, admissions for observation, laboratory testing, head CT, body CT, ankle radiographs, chest radiographs, and echocardiograms. Our estimates employed generalized estimating equations for logistic regression models adjusted for admission type, length of stay, and Charlson co-morbidity index. Marginal probabilities were used to calculate changes in outcome variables and their financial consequences. HIE data were accessed in approximately 6.8% of ED visits across 12 EDs studied. In 11 EDs directly accessing HIE data only through a secure Web browser, access was associated with a decrease in hospital admissions (adjusted odds ratio (OR)=0.27; p<0001). In a 12th ED relying more on print summaries, HIE access was associated with a decrease in hospital admissions (OR=0.48; p<0001) and statistically significant decreases in head CT use, body CT use, and laboratory test ordering. Applied only to the study population, HIE access was associated with an annual cost savings of $1.9 million. Net of annual operating costs, HIE access reduced overall costs by $1.07 million. Hospital admission reductions accounted for 97.6% of total cost reductions. Access to additional clinical data through HIE in emergency department settings is associated with net societal saving.
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DOI：
10.1136/amiajnl-2011-000432
发表时间：
2012-05
期刊：
Journal of the American Medical Informatics Association : JAMIA
影响因子：
--
作者：
Unertl KM;Johnson KB;Lorenzi NM
通讯作者：
Lorenzi NM
DOI：
10.1136/amiajnl-2011-000308
发表时间：
2011-09-01
影响因子：
6.4
作者：
Johnson, Kevin B.;Unertl, Kim M.;Frisse, Mark
通讯作者：
Frisse, Mark
影响因子：
--
作者：
Bourgeois, Fabienne C.;Olson, Karen L.;Mandl, Kenneth D.
通讯作者：
Mandl, Kenneth D.
影响因子：
120.7
作者：
Grumbach, K;Bodenheimer, T
通讯作者：
Bodenheimer, T
影响因子：
--
作者：
Byford, S;Raftery, J
通讯作者：
Raftery, J