Does Health Information Exchange Reduce Redundant Imaging? Evidence From Emergency Departments
Does Health Information Exchange Reduce Redundant Imaging? Evidence From Emergency Departments
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DOI：
10.1097/mlr.0000000000000067
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发表时间：
2014-03-01
期刊：
影响因子：
3
通讯作者：
Kocher, Keith E.
中科院分区：
文献类型：
--
作者：
Lammers, Eric J.;Adler-Milstein, Julia;Kocher, Keith E.
背景：基础广泛的电子健康信息交换(HIE)，患者的临床数据在不同的护理提供环境中跟踪他们，预计将产生巨大的质量收益和成本节约。目的：评估急诊科采用HIE是否与减少重复成像有关。数据来源/研究背景：将加利福尼亚州和佛罗里达州的州急诊部数据库中2007-2010年的ED出院数据与报告医院HIE参与的卫生信息管理系统协会的数据合并。方法：使用ED固定效应和趋势的回归方法，我们对参与HIE对重复成像的影响进行了回顾分析，比较了在研究期间启动HIE参与的37个急诊科和同期未参与HIE的410个急诊科。在3种常见的影像检查(CT、超声和胸部X光)中，我们定义了同一患者的重复图像，即在30天内在同一身体区域进行的独立ED检查。结果：在我们的样本中，重复CT 20,139次(占指数访问中CT病例的14.7%)，超声重复13,060次(占超声病例的20.7%)，重复胸部X光29,703次(占X线病例的19.5%)。HIE与所有3种方式重复ED成像的概率降低有关：CT-8.7个百分点[95%可信区间：-14.7，-2.7]，超声-9.1个百分点(95%CI：-17.2，-1.1)，胸部X线片-13.0个百分点(95%CI：-18.3，-7.7)，较样本均值减少44%-67%。这项研究是第一批找到HIE预期益处的经验支持之一。
Background:Broad-based electronic health information exchange (HIE), in which patients' clinical data follow them between care delivery settings, is expected to produce large quality gains and cost savings. Although these benefits are assumed to result from reducing redundant care, there is limited supporting empirical evidence.Objective:To evaluate whether HIE adoption is associated with decreases in repeat imaging in emergency departments (EDs).Data Source/Study Setting:ED discharge data from the State Emergency Department Databases for California and Florida for 2007-2010 were merged with Health Information Management Systems Society data that report hospital HIE participation.Methods:Using regression with ED fixed effects and trends, we performed a retrospective analysis of the impact of HIE participation on repeat imaging, comparing 37 EDs that initiated HIE participation during the study period to 410 EDs that did not participate in HIE during the same period. Within 3 common types of imaging tests [computed tomography (CT), ultrasound, and chest x-ray), we defined a repeat image for a given patient as the same study in the same body region performed within 30 days at unaffiliated EDs.Results:In our sample there were 20,139 repeat CTs (representing 14.7% of those cases with CT in the index visit), 13,060 repeat ultrasounds (20.7% of ultrasound cases), and 29,703 repeat chest x-rays (19.5% of x-ray cases). HIE was associated with reduced probability of repeat ED imaging in all 3 modalities: -8.7 percentage points for CT [95% confidence interval (CI): -14.7, -2.7], -9.1 percentage points for ultrasound (95% CI: -17.2, -1.1), and -13.0 percentage points for chest x-ray (95% CI: -18.3, -7.7), reflecting reductions of 44%-67% relative to sample means.Conclusions:HIE was associated with reduced repeat imaging in EDs. This study is among the first to find empirical support for this anticipated benefit of HIE.