Does Health Information Exchange Reduce Unnecessary Neuroimaging and Improve Quality of Headache Care in the Emergency Department?
Does Health Information Exchange Reduce Unnecessary Neuroimaging and Improve Quality of Headache Care in the Emergency Department?
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DOI：
10.1007/s11606-012-2092-7
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发表时间：
2013-02-01
影响因子：
5.7
通讯作者：
Frisse, Mark E.
中科院分区：
文献类型：
--
作者：
Bailey, James E.;Wan, Jim Y.;Frisse, Mark E.
健康信息交换（HIE）被提倡作为减少不必要的检测和提高急诊护理质量的方法，但很少有证据支持其使用。头痛是HIE理论上有益的一种特殊疾病。确定健康信息交换（HIE）是否减少了潜在的不必要的神经影像学，增加了对循证指南的依从性，并降低了急诊科（ED）头痛评估的成本。纵向数据分析：在2007年8月1日至2009年7月31日期间，所有1252名以头痛为症状的成年人（N = 2102）到孟菲斯市区急诊科就诊两次或两次以上。授权急诊科人员使用连接15家主要成人医院和两个区域诊所系统的区域性HIE，访问患者在急诊科就诊期间的患者记录。诊断神经影像学（CT、CT血管造影、MRI或MRI血管造影）、循证指南依从性和患者总就诊估计费用。21.8%因头痛就诊的急诊科患者获得了HIE数据。69.8%接受了神经影像学检查。HIE与诊断神经影像学的几率降低（比值比[OR] 0.38，可信区间[CI] 0.29-0.50）和对循证指南的依从性增加（比值比[OR] 1.33，可信区间[CI] 1.02-1.73）相关。行政/护理人员的HIE使用（OR 0.24, CI 0.17-0.34）在调整混杂因素后也与神经影像学下降有关。HIE的总体使用与成本的显著变化无关。HIE与头痛急诊评估中诊断成像减少和循证指南依从性增加相关，但与总成本的改善无关。需要进行对照试验来测试特定的HIE增强以增加HIE的使用是否可以进一步减少潜在的不必要的诊断成像，并提高对指南的依从性，同时降低护理成本。
Health information exchange (HIE) is advocated as an approach to reduce unnecessary testing and improve quality of emergency department (ED) care, but little evidence supports its use. Headache is a specific condition for which HIE has theoretical benefits.To determine whether health information exchange (HIE) reduces potentially unnecessary neuroimaging, increases adherence with evidence-based guidelines, and decreases costs in the emergency department (ED) evaluation of headache.Longitudinal data analysisAll repeat patient-visits (N = 2,102) by all 1,252 adults presenting with headache to a Memphis metropolitan area ED two or more times between August 1, 2007 and July 31, 2009.Use of a regional HIE connecting the 15 major adult hospitals and two regional clinic systems by authorized ED personnel to access the patient's record during the time period in which the patient was being seen in the ED.Diagnostic neuroimaging (CT, CT angiography, MRI or MRI angiography), evidence-based guideline adherence, and total patient-visit estimated cost.HIE data were accessed for 21.8 % of ED patient-visits for headache. 69.8 % received neuroimaging. HIE was associated with decreased odds of diagnostic neuroimaging (odds ratio [OR] 0.38, confidence interval [CI] 0.29-0.50) and increased adherence with evidence-based guidelines (OR 1.33, CI 1.02-1.73). Administrative/nursing staff HIE use (OR 0.24, CI 0.17-0.34) was also associated with decreased neuroimaging after adjustment for confounding factors. Overall HIE use was not associated with significant changes in costs.HIE is associated with decreased diagnostic imaging and increased evidence-based guideline adherence in the emergency evaluation of headache, but was not associated with improvements in overall costs. Controlled trials are needed to test whether specific HIE enhancements to increase HIE use can further reduce potentially unnecessary diagnostic imaging and improve adherence with guidelines while decreasing costs of care.