Advancing Quality Measurement and Care Improvement with Health Information Exchan

描述(由申请人提供)：此应用程序的目标是创建和验证两个拟议的国家质量论坛(NQF)电子质量衡量标准的启用卫生信息交换(HIE)的版本，用于潜在可预防的急诊科(ED)就诊：1)在72小时内返回急诊科(ED)(ED返还)和2)经常使用急诊科用户，然后评估它们对目前仅使用“孤立”机构特定数据的干预措施的影响。该项目将与纽约临床信息交换(NYCLIX)一起实施，NYCLIX是一个现有的HIE，横跨纽约市(NYC)的大多数主要医院。 目前的质量衡量方法的一个局限性是，它通常是特定于机构的，限于单一的供应商组织。HIE的出现为以新的方式思考质量提供了机会，并创建了新的以患者为中心的质量衡量标准，无论患者在哪里寻求护理，都可以收集数据。 本申请中的具体假设是：1)启用HIE的电子质量措施将允许更好地检测ED质量保证(QA)案例和经常使用ED的用户，以及2)在正在进行的计划中使用这些措施将改进ED QA流程并减少经常使用ED的用户的访问次数。 该项目的目的是：1)开发和验证基于卫生信息交换的工具，以支持针对ED退货和频繁ED用户的新的机构间电子质量措施；2)用定量和定性的方法比较新的机构间电子质量措施与当前特定地点的措施的绩效；3)在现有的质量保证和病例管理计划中实施新的机构间电子质量措施，并量化其影响。 主要结果包括在72小时回程中捕获的患者数量以及在使用和不使用新的机构间措施的情况下经常使用急诊室的队列。次要结果包括构成质素问题的72小时退还个案数目，以及经常使用教育署的人士在实施新的跨机构措施和不采用新的跨机构措施的情况下的访问次数。 公共卫生相关性：该项目将通过检测患者在一个地点首次就诊后72小时内在多个急诊室返回的时间，来改进个人在急诊室接受的护理的质量衡量。72小时退货被认为是首次就诊时潜在质量问题的一个指标。这个项目将提供一种方法，减少经常使用急诊室的用户访问急诊室的次数，可能会减少剩余人口的急诊室的拥挤程度。

DESCRIPTION (provided by applicant): The goal of this application is to create and validate health information exchange (HIE)-enabled versions of two proposed National Quality Forum (NQF) e-Quality measure for potentially preventable emergency department (ED) visits: 1) returns to the ED within 72 hours (ED returns) and 2) frequent ED users, then evaluate their impact on interventions currently using only "siloed" institution-specific data. The project will b implemented with the New York Clinical Information Exchange (NYCLIX), an existing HIE that spans most of the major hospitals in New York City (NYC). One limitation to the current approach to quality measurement is that it is usually institution- specific, limited to a single provider organization. The advent of HIE presents an opportunity to think about quality in new ways and create new patient-centric quality measures that gather data wherever patients seek care. The specific hypotheses in this application are that 1) HIE-enabled e-Quality measures will allow better detection of ED quality assurance (QA) cases and frequent ED users and 2) use of these measures in ongoing programs will improve ED QA processes and decrease the number of visits by frequent ED users. The Aims of this project are 1) Develop and validate a health information exchange-based tool to support new inter-institutional e-Quality measures for ED returns and frequent ED users, 2) Compare the performance of the new inter-institutional e-Quality measures to current site- specific measures with quantitative and qualitative methods and 3) Implement the new inter- institutional e-Quality measures in existing QA and case management programs and quantify the impact. The primary outcomes include the number of patients captured in the 72-hour return and frequent ED user cohorts with and without the new inter-institutional measures. Secondary outcomes include the number of 72-hour return cases constituting quality issues, and the number of visits by frequent ED users with and without the new inter-institutional measures. PUBLIC HEALTH RELEVANCE: This project will provide improved quality measurement of the care individuals receive in emergency departments (EDs) by detecting when patients return within 72- hours across numerous EDs following an initial ED visit at one site. 72-hour returns are considered an indicator of potential quality problems on the initial visit. This project will aso provide a means to decrease ED visits by frequent users, potentially leading to less crowded EDs for the remaining population.