Health Information Exchange to Improve Outcomes in Complex Older Patients

项目摘要摘要 由于我们的医疗保健提供系统支离破碎，在医疗保健提供中共享患者的健康信息 组织是高质量护理的重要组成部分，但并不是例行公事。当生命垂危时 信息缺失，护理连续性受到阻碍，患者预后不良的风险增加。老年人 有不成比例的复杂健康状况，导致他们需要去看多个提供者 在不同的组织中。因此，他们面临着不成比例的风险，因为缺乏 信息共享，包括重复检测和避免住院。改善信息共享 在医疗保健提供组织中，在过去的八年里，已经做出了巨大的努力来促进 采用电子健康记录以及它们之间共享患者数据的能力(“健康信息 交换“或HIE)。然而，令人惊讶的是，几乎没有证据表明HIE是否以 使老年人受益，无论是在确保治疗同一患者的医疗组织方面 人们能够相互参与HIE，当他们这样做时，他们以改进的方式使用HIE 临床结果(例如，减少重复检测和住院)。 我们的项目将提供全国范围的医疗保健提供组织在多大程度上例行公事地 治疗同样年长的患者能够以电子方式彼此共享患者信息。今天，没有这样的 措施存在，在理解是否存在连接方面造成了一个有问题的盲点 这是最需要的。此外，在医疗保健提供组织参与共享患者的情况下 通过电子信息，我们将评估它是否改善了接受 来自这些组织的关怀。这些结果包括重复检测、住院和再住院，以及 死亡率。重要的是，我们将评估电子信息共享的好处是否不成比例 由于缺乏信息共享，两类患者的预后不良风险最大： 那些患有痴呆症和有多种健康状况的人。通过关注这些人群，我们将能够 确定当前电子健康信息共享的“一刀切”方法是否奏效 或者是否需要针对不同患者群体的独特需求进行定制。 通过生成关于跨医疗保健的电子健康信息共享现状的新证据 研究结果将指导关键利益攸关方如何应对护理分散的风险 通过分享信息的方式，改善老年人和最脆弱的人的结果 尤其是老年人。

Project Summary Abstract Due to our fragmented healthcare delivery system, sharing patient health information across healthcare delivery organizations is an essential component of high-quality care but does not occur routinely. When critical health information is missing, care continuity is impeded, with increased risk of poor patient outcomes. Older adults have a disproportionate share of complex health conditions that result in their needing to see multiple providers in different organizations. They are therefore at disproportionate risk of poor outcomes that result from lack of information sharing, including repeated testing and avoidable hospitalization. To improve information sharing across healthcare delivery organizations, there has been a substantial effort over the past eight years to promote adoption of electronic health records and the ability to share patient data between them (“health information exchange” or HIE). However, there is surprisingly little evidence about whether HIE is occurring in ways that will benefit older adults, both in terms of ensuring that the healthcare organizations that treat the same patient populations are able to engage in HIE with each other and, when they are, that they use HIE in ways that improve clinical outcomes (e.g., reduce repeat testing and hospitalization). Our project will provide a national picture of the extent to which healthcare delivery organizations that routinely treat the same older patients are able to share patient information electronically with each other. Today, no such measures exist, creating a problematic blindspot in terms of understanding whether there is connectivity where it is most needed. In addition, where healthcare delivery organizations are engaging in sharing patient information electronically, we will assess whether it is improving key outcomes for the older patients that receive care from those organizations. These outcomes include repeat testing, hospitalization and rehospitalization, and mortality. Importantly, we will assess whether the benefits from electronic information sharing disproportionately accrue to two populations of patients who are most at risk of poor outcomes from lack of information sharing: those with dementia and those with multiple health conditions. By focusing on these populations, we will be able to determine whether the current “one-size-fits-all” approach to electronic health information sharing is working or whether it requires customization to the unique needs of different patient populations. By generating new evidence on the current state of electronic health information sharing across healthcare delivery organizations, study results will guide key stakeholders on how to combat the risks of care fragmentation by sharing information in ways that improve outcomes for older adults in general, and for the most vulnerable older adults in particular.