Effects of health information exchange adoption on ambulatory testing rates.
Effects of health information exchange adoption on ambulatory testing rates.
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健康信息交换采用对动态检测率的影响。
DOI：
10.1136/amiajnl-2012-001608
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发表时间：
2013
期刊：
影响因子：
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通讯作者：
NeaseJr,DonaldE
中科院分区：
文献类型：
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作者：
Ross,StephenE;Radcliff,TiffanyA;Leblanc,WilliamG;Dickinson,LMiriam;Libby,AnneM;NeaseJr,DonaldE
目的探讨门诊电子健康信息交换（HIE）对实验室和放射科诊断率及允许收费的影响。从2005年4月1日至2010年12月31日，科罗拉多州梅萨县主要健康计划的设计索赔数据与提供者层面的HIE采用数据相匹配。采用混合效应回归模型，以季度为分析单位，评估了采用HIE对检测率和相关费用的影响。结果对69家诊所、34,818名患者的306名医疗服务提供者提交的索赔进行了分析。每个提供者的检测率表示为每季度每1000名患者的检测率。对于初级保健提供者，实验室检测率随时间推移而增加（基线1041次/1000例患者/季度，每季度增加13.9次），并随着HIE的采用而下降（下降83次，p<0.01）。在专科医生中也发现了类似的效果（基线为718次/1000名患者/季度，每季度增加19.1次，HIE的采用与下降的119次相关，p<0.01）。即便如此，在两组提供者中，计算的实验室检测费用并没有明显下降，这可能是由于这些数据有偏差。对于放射学检测，HIE的采用与两组提供者的费率或估算费用的显著变化无关。结论抽检性HIE的采用不太可能通过降低检测率而产生显著的直接节约。HIE的经济效益可能存在于其他下游结果，即更好的信息，更高质量的护理。
ObjectiveTo determine the effects of the adoption of ambulatory electronic health information exchange (HIE) on rates of laboratory and radiology testing and allowable charges.DesignClaims data from the dominant health plan in Mesa County, Colorado, from 1 April 2005 to 31 December 2010 were matched to HIE adoption data on the provider level. Using mixed effects regression models with the quarter as the unit of analysis, the effect of HIE adoption on testing rates and associated charges was assessed.ResultsClaims submitted by 306 providers in 69 practices for 34 818 patients were analyzed. The rate of testing per provider was expressed as tests per 1000 patients per quarter. For primary care providers, the rate of laboratory testing increased over the time span (baseline 1041 tests/1000 patients/quarter, increasing by 13.9 each quarter) and shifted downward with HIE adoption (downward shift of 83, p<0.01). A similar effect was found for specialist providers (baseline 718 tests/1000 patients/quarter, increasing by 19.1 each quarter, with HIE adoption associated with a downward shift of 119, p<0.01). Even so, imputed charges for laboratory tests did not shift downward significantly in either provider group, possibly due to the skewed nature of these data. For radiology testing, HIE adoption was not associated with significant changes in rates or imputed charges in either provider group.ConclusionsAmbulatory HIE adoption is unlikely to produce significant direct savings through reductions in rates of testing. The economic benefits of HIE may reside instead in other downstream outcomes of better informed, higher quality care.