The Impact of Health Information Exchange on In-Hospital and Postdischarge Mortality in Older Adults with Alzheimer Disease Readmitted to a Different Hospital Within 30 Days of Discharge: Cohort Study of Medicare Beneficiaries.
The Impact of Health Information Exchange on In-Hospital and Postdischarge Mortality in Older Adults with Alzheimer Disease Readmitted to a Different Hospital Within 30 Days of Discharge: Cohort Study of Medicare Beneficiaries.
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DOI：
10.2196/41936
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发表时间：
2023-03-10
期刊：
影响因子：
4.9
通讯作者：
Ali, Mohammed K.
中科院分区：
文献类型：
--
作者：
Turbow, Sara;Vaughan, Camille P.;Culler, Steven;Hepburn, Kenneth W.;Rask, Kimberly J.;Perkins, Molly M.;Clevenger, Carolyn K.;Ali, Mohammed K.
关键词：
虽然电子健康信息共享正在全国范围内扩大，但目前尚不清楚电子健康信息共享是否能改善患者的预后，特别是对于那些面临沟通挑战风险最高的患者，如老年痴呆症患者。确定参与医院级健康信息交换（HIE）与患有阿尔茨海默病或因几种常见疾病之一入院后30天再入院不同医院的Medicare受益人的院内或出院后死亡率之间的关联。这是一项针对患有阿尔茨海默病的医疗保险受益人的队列研究，这些受益人在2018年首次入院后有一次或多次30天的再入院，以选择医院再入院减少计划条件（急性心肌梗死、充血性心力衰竭、慢性阻塞性肺病和肺炎）或老年阿尔茨海默病患者住院的常见原因（脱水、晕厥、尿路感染或行为问题）。使用未校正和校正的logistic回归，我们研究了电子信息共享与再入院期间住院死亡率或再入院后30天内死亡率之间的关系。共纳入28，946对入院-再入院对。同一医院再入院的受益人年龄（81.1岁，SD 8.6岁）大于不同医院再入院的受益人（年龄范围79.8-80.3岁，P<0.001）。与同一家医院的入院和再入院相比，再次入院至与入院医院共享HIE的不同医院的受益人在再入院期间死亡的几率降低了39%（调整后的比值比[AOR] 0.61，95%CI 0.39-0.95）。在参加不同HIE的不同医院的入院-再入院对中，观察到的院内死亡率没有差异（AOR 1.02，95%CI 0.82-1.28）或其中一家或两家医院均未参与HIE的不同医院（AOR 1.25，95%CI 0.93-1.68），并且信息共享与出院后死亡率之间无相关性。这些结果表明，通过共享HIE在不相关的医院之间共享信息可能与较低的住院死亡率相关，但与老年阿尔茨海默病患者的出院后死亡率无关。如果入院和再入院医院参与不同的HIE，或者如果一家或两家医院都不参与HIE，则在再入院到不同医院期间的院内死亡率较高。该分析的局限性包括HIE参与是在医院层面而不是在提供者层面进行测量的。这项研究提供了一些证据，表明HIEs可以改善从不同医院接受急性护理的弱势人群的护理。
Although electronic health information sharing is expanding nationally, it is unclear whether electronic health information sharing improves patient outcomes, particularly for patients who are at the highest risk of communication challenges, such as older adults with Alzheimer disease. To determine the association between hospital-level health information exchange (HIE) participation and in-hospital or postdischarge mortality among Medicare beneficiaries with Alzheimer disease or 30-day readmissions to a different hospital following an admission for one of several common conditions. This was a cohort study of Medicare beneficiaries with Alzheimer disease who had one or more 30-day readmissions in 2018 following an initial admission for select Hospital Readmission Reduction Program conditions (acute myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease, and pneumonia) or common reasons for hospitalization among older adults with Alzheimer disease (dehydration, syncope, urinary tract infection, or behavioral issues). Using unadjusted and adjusted logistic regression, we examined the association between electronic information sharing and in-hospital mortality during the readmission or mortality in the 30 days following the readmission. A total of 28,946 admission-readmission pairs were included. Beneficiaries with same-hospital readmissions were older (aged 81.1, SD 8.6 years) than beneficiaries with readmissions to different hospitals (age range 79.8-80.3 years, P<.001). Compared to admissions and readmissions to the same hospital, beneficiaries who had a readmission to a different hospital that shared an HIE with the admission hospital had 39% lower odds of dying during the readmission (adjusted odds ratio [AOR] 0.61, 95% CI 0.39-0.95). There were no differences in in-hospital mortality observed for admission-readmission pairs to different hospitals that participated in different HIEs (AOR 1.02, 95% CI 0.82-1.28) or to different hospitals where one or both hospitals did not participate in HIE (AOR 1.25, 95% CI 0.93-1.68), and there was no association between information sharing and postdischarge mortality. These results indicate that information sharing between unrelated hospitals via a shared HIE may be associated with lower in-hospital, but not postdischarge, mortality for older adults with Alzheimer disease. In-hospital mortality during a readmission to a different hospital was higher if the admission and readmission hospitals participated in different HIEs or if one or both hospitals did not participate in an HIE. Limitations of this analysis include that HIE participation was measured at the hospital level, rather than at the provider level. This study provides some evidence that HIEs can improve care for vulnerable populations receiving acute care from different hospitals.
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DOI：
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影响因子：
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影响因子：
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