The associations between query-based and directed health information exchange with potentially avoidable use of health care services.
The associations between query-based and directed health information exchange with potentially avoidable use of health care services.
复制标题
基于查询和定向的健康信息交换与可能可以避免的医疗保健服务的使用之间的关联。
DOI：
10.1111/1475-6773.13169
复制
发表时间：
2019
影响因子：
3.4
通讯作者：
Casalino,LawrenceP
中科院分区：
文献类型：
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作者：
Vest,JoshuaR;Unruh,MarkAaron;Shapiro,JasonS;Casalino,LawrenceP
目的量化健康信息交换(HIE)的两种方法(直接和基于查询)对潜在可避免的医疗服务使用的影响。数据来源/研究设置2008-2014年间，将门诊服务提供者采用HIE的数据与医疗保险收费服务索赔合并。提供者来自纽约罗切斯特地区卫生信息组织(RHIO)服务的13个县。研究设计考虑提供者和年份固定效应的线性回归模型被用来估计归因于提供者采用定向和/或基于查询的HIE的医疗保险受益人与归因于未采用HIE的提供者的受益人的使用结果的概率的变化。数据收集提供者的HIE采用状态通过罗切斯特RHIO的登记记录来确定。RHIO和索赔数据通过国家提供者标识符相关联。主要发现基于查询的HIE采用与门诊护理敏感住院的可能性降低0.2个百分点和计划外再次住院的可能性降低1.1个百分点相关。结论医疗保险和医疗补助服务中心(CMS)的EHR认证标准包括对直接HIE的要求，但不包括基于查询的HIE。在进一步研究之前，认证标准应同等重视促进基于查询的交流和定向交流。
ObjectiveTo quantify the impact of two approaches (directed and query‐based) to health information exchange (HIE) on potentially avoidable use of health care services.Data Sources/Study SettingData on ambulatory care providers’ adoption of HIE were merged with Medicare fee‐for‐service claims from 2008 to 2014. Providers were from 13 counties in New York served by the Rochester Regional Health Information Organization (RHIO).Study DesignLinear regression models with provider and year fixed effects were used to estimate changes in the probability of utilization outcomes for Medicare beneficiaries attributed to providers adopting directed and/or query‐based HIE compared with beneficiaries attributed to providers who had not adopted HIE.Data CollectionProviders’ HIE adoption status was determined through Rochester RHIO registration records. RHIO and claims data were linked via National Provider Identifiers.Principal FindingsQuery‐based HIE adoption was associated with a 0.2 percentage point reduction in the probability of an ambulatory care sensitive hospitalization and a 1.1 percentage point decrease in the likelihood of an unplanned readmission. Directed HIE adoption was not associated with any outcome.ConclusionsThe Centers for Medicare & Medicaid Services’ (CMS) EHR certification criteria includes requirements for directed HIE, but not query‐based HIE. Pending further research, certification criteria should place equal weight on facilitating query‐based and directed exchange.