Improving Mental Health Outcomes with the Emergency Department Information Exchange (EDIE): Insights from Washington State

项目摘要 本研究的总体目标是了解如何利用健康信息交换来改善 精神疾病患者的医疗补助结果。与心理健康相关的艾德就诊增加了更多 在过去的十年中超过50%，医疗补助吸收了大部分相关的急性护理费用。 患有精神疾病的医疗补助患者经常经历分散的护理和不良结果，包括高 可预防的艾德就诊率和住院率，与没有精神疾病的人相比。因此，委员会认为， 减少可预防的医院使用一直是州医疗补助机构的中心目标。患者频繁 使用紧急服务是改善护理提供的干预措施的关键目标群体，但他们的临床 需求与其他患者截然不同-超过一半的患者患有精神健康或物质使用障碍， 超过三分之一的人患有多种慢性病，65%的人是残疾人。卫生信息交流 是一个很有前途的战略，以促进这些高需求的医疗补助患者的护理协调。在2012年， 华盛顿州要求所有医院实施并战略性地使用HIE， 急诊科信息交换（EDIE）作为其“急诊室是紧急情况”计划的一部分。伊迪 旨在帮助医院识别紧急服务的频繁用户， 为高需求患者制定护理计划和病例管理，并改善患者之间的数据共享。 门诊提供者和医院。EDIE的使用，特别是电子护理计划的开发， 在各种政策杠杆和对医院的财政激励的支持下， 伙伴关系，为州一级的持续改进提出建议。然而，迄今为止， 对患者预后的影响尚未得到系统评估。尽管如此，EDIE和类似的HIE平台， 目前正在其他几个州的医疗补助计划中推出。因此，拟议的研究旨在 了解EDIE是否以及如何改善艾德频繁使用者的心理健康结果， 华盛顿州。使用纵向医疗补助索赔链接到各种管理数据源， 医院和社区的特点，我们将1）检查EDIE在医院之间的吸收趋势，2） 确定EDIE在多大程度上改善了患者的整体心理健康结果， 精神疾病患者的亚组，以及3）确定卫生系统特征 提高EDIE的有效性。拟议的工作将有助于我们了解 HIE促进的护理协调的有效性，包括人口、医院和社区， 最有可能从中获益。

PROJECT SUMMARY The overall goal of this study is to understand how health information exchange can be leveraged to improve outcomes for Medicaid patients with mental illness. Mental health-related ED visits have increased by more than 50% in the past decade, with Medicaid absorbing the majority of the associated acute-care costs. Medicaid patients with mental illness often experience fragmented care and poor outcomes, including high rates of preventable ED visits and hospitalizations, compared to those without mental illness. Consequently, reducing preventable hospital use has been a central goal of state Medicaid agencies. Patients with frequent use of emergency services are key target group for interventions to improve care delivery, yet their clinical needs are profoundly different from other patients - over half have a mental health or substance use disorder, more than a third have multiple chronic conditions, and 65% are disabled. Health information exchange (HIE) is a promising strategy to facilitate care coordination for these high-needs Medicaid patients. In 2012, Washington state mandated all hospitals to implement and strategically use an HIE referred to as the Emergency Department Information Exchange (EDIE) as part of its “ER is for Emergencies” program. EDIE was designed to assist hospitals with identifying frequent users of emergency services, facilitate the active development care plans and case management for high-needs patients, and improve data sharing between outpatient providers and hospitals. The use of EDIE, especially the development of electronic care plans, is supported by a variety of policy levers and financial incentives to hospitals, as well as a public-private partnership that makes recommendations for ongoing improvement at the state-level. Yet, to date, its impact on patient outcomes has not been systematically evaluated. Despite this, EDIE and similar HIE platforms are currently being rolled-out in several other state Medicaid programs. Thus, the proposed study aims to understand whether and how EDIE has improved mental health outcomes for frequent users of the ED in Washington state. Using longitudinal Medicaid claims linked to a variety of administrative data sources on hospital and community characteristics we will 1) examine trends in the uptake of EDIE across hospitals, 2) determine the extent to which EDIE improved mental health outcomes for patients overall as well as key subgroups of patients with mental illness, and 3) determine the extent to which health system characteristics enhance the effectiveness of EDIE. The proposed work will contribute to our understanding of the effectiveness of HIE-facilitated care coordination, including the populations, hospitals, and communities that are most likely to reap benefits.