Hospitals' Adoption of EHRs and Re-hospitalization of Medicare Beneficiaries

项目总结/摘要 医疗保险受益人的再住院是频繁的，昂贵的，是效率低下和/或穷人的指标。 护理质量。老年患者特别容易再次入院。最近的政策变化，如 制定了《减少再次入院方案》，对有风险的医院进行处罚， 调整后的再入院率高于全国平均水平，进一步重视减少这些 事件出于这些原因，供应商和政策制定者做出了大量努力，以减少再生产。 住院率。实施电子健康记录（EHR）可能是一种有效的方法 来减少再入院国家对电子健康档案进行了前所未有的投资， 通过卫生信息技术促进经济和社会发展， 2009年《临床卫生（HITECH）法》。根据HITECH，通过以下方式提供财政奖励： 有意义的使用，要求参与医院实现中心规定的特定目标， 医疗保险和医疗补助服务。这些激励措施预计将使美国医院增加25% 采用电子健康记录，否则不会选择这样做，从而导致整体预期采用率 的85%。电子健康记录促进了临床信息的可用性，并与改善 护理质量。如果这些质量改进降低了再次住院的可能性，作为早期证据， 提示，EHR可能提供一种有效的干预措施，以降低再住院率。在这项研究中，我们将 首先描述医院采用EHR的模式。一个特别的重点将放在医院， 为不成比例的贫困患者提供服务，以检查以前记录的“数字鸿沟” 通过有意义的使用提供的激励措施持续存在或加剧。这将与 回归分析，以确定医院的特点，如医疗补助出院的比例， 与参与有意义的使用有关。这项拟议的研究将提供证据， 对老年医疗保险受益人再住院率的影响。为了实现这一目标， 将进行回归分析，以量化医院参与 有意义的使用，以及在没有参与有意义的使用的情况下采用EHR， 老年人医疗保险受益人同时参加Medicare和Medicaid的双重资格受益人可能是 特别是有再次住院的风险。因此，我们将使用双重资格受益人的样本， 医院采用电子健康记录对再次住院的影响使用相同的分析方法。结果 这项研究的结果将提供证据，证明美国通过投资于 电子病历

PROJECT SUMMARY/ABSTRACT Re-hospitalization of Medicare beneficiaries is frequent, costly and is an indicator of inefficient and/or poor quality of care. Elderly patients are particularly susceptible to readmissions. Recent policy changes, such as the establishment of the Hospital Readmissions Reduction Program which penalizes hospitals with risk- adjusted readmission rates above the national mean, have placed further importance on reducing these events. For these reasons, providers and policymakers have engaged in substantial efforts to reduce re- hospitalization rates. Implementation of electronic health records (EHRs) may be an effective approach towards reducing readmissions. The nation has made an unprecedented investment in EHRs by making approximately $30 billion available to providers through the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009. Under HITECH, financial incentives are made available through Meaningful Use, which requires participating hospitals to fulfill certain objectives defined by the Center for Medicare and Medicaid Services. The incentives are expected to lead to an additional 25% of US hospitals adopting EHRs that otherwise would not have chosen to do so resulting in an overall anticipated adoption rate of 85%. EHRs facilitate the availability of clinical information and have been associated with improvements in the quality of care. If these quality improvements reduce the likelihood of re-hospitalization, as early evidence suggests, EHRs may provide an effective intervention for reducing re-hospitalization rates. In this study, we will first characterize EHR adoption patterns among hospitals. A particular focus will be placed on hospitals that serve a disproportionate share of poor patients to examine whether a previously documented "digital divide" has persisted or been exacerbated by the incentives offered through Meaningful Use. This will be done with regression analysis to identify hospital characteristics, such as the proportion of Medicaid discharges, associated with participation in Meaningful Use. The proposed study will then provide evidence of EHRs' influence on re-hospitalization rates of elderly Medicare beneficiaries. To achieve this goal, a fixed effects regression analysis will be undertaken to quantify the relationship between hospitals' participation in Meaningful Use, and adoption of EHRs without participation in Meaningful Use, on the 30-day readmissions of elderly Medicare beneficiaries. Dually-eligible beneficiaries participating in both Medicare and Medicaid may be at particular risk of re-hospitalization. Therefore, using a sample of dually-eligible beneficiaries, we will assess the impact of hospitals' adoption of EHRs on re-hospitalization using the same analytic approach. The results of the study will provide evidence of the value added to health care in US through the nation's investment in EHRs.