Evaluation of VLER_Indiana Health Information Exchange Demonstration Project

描述(由申请人提供)： 背景：印第安纳波利斯退伍军人管理局和印第安纳健康信息交换(IHIE)将通过VLER健康计划合作，进行双向健康信息交换(HIE)。退伍军人-IHIE计划将选择参加该计划的退伍军人的外部电子健康记录在护理地点向他们的退伍军人和非退伍军人提供者提供。关于缺氧缺血性脑病对医疗质量和成本的影响，从经验上讲知之甚少。目的1：评估退伍军人在退伍军人医院外获得的医疗保健的比例和预测因素。目标2：评估退伍军人IHIE对医疗质量的影响“假设1：实施VA-IHIE将改善退伍军人的门诊护理质量”假设2：实施VA-IHIE将降低退伍军人对门诊敏感疾病的住院率“假设3：实施VA-IHIE将减少退伍军人过度使用医疗检查目标3：探讨实施VA-IHIE是否将减少退伍军人研究人群的医疗经济支出：我们的研究人群是在印第安纳波利斯退伍军人管理局和与IHIE有关的非退伍军人管理局就诊的退伍军人患者，如此一来，就有了医疗信息交流。在实施组，VA-IHIE计划将向过去15个月在印第安纳波利斯VA就诊的2000名退伍军人患者提供。控制组将包括退伍军人，他们在退伍军人管理局之外拥有额外的医疗保健数据，他们的信息交换尚未启动。研究设计：将在印第安纳波利斯退伍军人中对VA-IHIE实施进行事前评估，同时设立控制组。我们将使用倾向评分方法来模拟随机化，因为由于实施限制，患者不会被随机化到VA-IHIE激活。退伍军人接受护理的数据将在退伍军人-IHIE登记前一年和登记后一年获得。数据将从退伍军人管理局和IHIE电子健康记录信息中提取。措施：我们将从(1)门诊护理服务使用不足和(2)过度使用体检两个方面衡量HIE对医疗质量的影响。鉴于过度使用措施普遍发展不足，我们将召集一组专家小组，以促进制定一套过度使用措施。最后，我们将衡量VA-IHIE实施前后的经济支出。我们将基于我们的概念框架来衡量可能影响VA-IHIE影响的潜在协变量。这些因素包括VA-IHIE访问(或HIE交易)、提供者相互依赖(利用)、患者复杂性(社会人口学特征、疾病和合并症)，以及VA以外可获得的临床数据的数量和类型。

DESCRIPTION (provided by applicant): Background: The Indianapolis VA and Indiana Health Information Exchange (IHIE) will partner through the VLER HEALTH program to perform bi-directional health information exchange (HIE). The VA-IHIE program will deliver the outside electronic health records of Veterans who opt-in to the program to their VA and non-VA providers at the point of care when they are seen. Little is known empirically about the effect of HIE upon health care quality and cost. Aim 1: to assess the proportion and predictors of health care received by Veterans outside the VA Aim 2: to assess the impact of VA-IHIE upon the quality of care received by Veterans " Hypothesis 1: implementation of VA-IHIE will improve the quality of ambulatory care among Veterans " Hypothesis 2: implementation of VA-IHIE will reduce admission rates for ambulatory care sensitive conditions among Veterans " Hypothesis 3: implementation of VA-IHIE will reduce overuse of medical tests among Veterans Aim 3: to explore whether the implementation of VA-IHIE will reduce the economic expenditures of health care for Veterans Study Population: Our study population is Veteran patients who have been seen at both the Indianapolis VA and a non-VA medical institution associated with IHIE and, thus, have health care information to exchange. In the implementation group, the VA-IHIE program will be delivered to 2,000 Veteran patients who have been seen at the Indianapolis VA in the past 15 months. The control group will include Veterans with additional health care data outside the VA, for whom information exchange has not been activated. Study Design: A pre-post evaluation of the VA-IHIE implementation, with a concurrent control group, will be performed among Veterans seen at the Indianapolis VA. We will use a propensity score approach to mimic randomization since the patients will not be randomized to VA-IHIE activation due to implementation constraints. Data on care received by Veterans will be obtained for one year before, and one year after, VA-IHIE enrollment. Data will be drawn from VA and IHIE electronic health record information. Measures: We will measure the impact of HIE upon health care quality in terms of both the (1) underuse of ambulatory care services and (2) overuse of medical tests. Given that overuse measures are generally underdeveloped, we will convene a set of expert panels to facilitate the development of a set of overuse measures. Finally, we will measure economic expenditures before and after VA-IHIE implementation. We will measure potential covariates that may affect the impact of VA-IHIE based upon our conceptual framework. These factors include VA-IHIE access (or HIE transactions), provider interdependence (utilization), and patient complexity (sociodemographic characteristics, diseases, and comorbidity), as well the amount and type of clinical data available outside the VA.