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

通过急诊科信息交换 (EDIE) 改善心理健康结果：来自华盛顿州的见解

• 批准号: 9805962
• 负责人: Amber Kathleen Sabbatini
• 金额: $ 36.03万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-08 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9805962
• 关键词: Accident and Emergency department; Acute; Address; Alcohol or Other Drugs use; American Hospital Association; Area; Behavioral; Caring; Case Management; Case Mixes; Characteristics; Clinical; Communities; Data; Data Sources; Development; Disabled Persons; Effectiveness; Emergency Department evaluation; Emergency Situation; Emergency department visit; Emergency medical service; Goals; Health; Health Resources; Health system; Healthcare; Hospital Administrators; Hospitalization; Hospitals; Impact evaluation; Infusion procedures; Link; Medicaid; Mental Health; Mental Health Services; Mental disorders; Methodology; Methods; Modeling; Outcome; Outpatients; Patient-Focused Outcomes; Patients; Physicians; Policies; Population; Process Measure; Provider; Psyche structure; Quality of Care; Recommendation; Reporting; Resources; Statutes and Laws; Substance Use Disorder; Surveys; Testing; Time; Translating; Vendor; Washington; Work; authority; care coordination; care costs; care delivery; care outcomes; cost effective; data sharing; design; experience; financial incentive; follow-up; group intervention; improved; improved outcome; innovation; insight; medication compliance; multiple chronic conditions; novel; patient population; patient subsets; programs; public-private partnership; service engagement; trend; uptake

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.

项目总结 这项研究的总体目标是了解如何利用卫生信息交流来改善 患有精神疾病的医疗补助患者的结果。与精神健康相关的急诊科就诊增加了更多 在过去十年中，医疗补助承担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零散的护理和糟糕的结果，包括高 可预防的急诊率和住院率，与那些没有精神疾病的人相比。因此， 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。频繁发作的患者 急救服务的使用是改善护理提供的干预措施的主要目标群体，但他们的临床 需求与其他患者有很大不同--超过一半的患者有心理健康或药物使用障碍， 超过三分之一的人患有多种慢性病，65%的人是残疾人。卫生信息交换(HIE) 是一个有希望的战略，以促进这些高需求的医疗补助患者的护理协调。2012年， 华盛顿州要求所有医院实施并战略性地使用HIE 紧急情况信息交换(EDIE)，作为其“紧急情况”计划的一部分。伊迪 旨在帮助医院识别经常使用急救服务的人，方便活跃的 为高需求患者制定护理计划和病例管理，并改善数据共享 门诊提供者和医院。伊迪的使用，特别是电子护理计划的开发， 得到各种政策杠杆和对医院以及公私营部门的财政激励的支持 为州一级的持续改进提出建议的伙伴关系。然而，迄今为止，它的影响 对患者预后的影响还没有得到系统的评估。尽管如此，伊迪和类似的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 了解伊迪是否以及如何改善经常使用ED的人的心理健康状况 华盛顿州。使用链接到各种管理数据源的纵向医疗补助报销申请 医院和社区特征我们将1)检查跨医院感染伊迪的趋势，2) 确定伊迪在多大程度上改善了患者的心理健康结果，以及关键 精神疾病患者的亚组，以及3)确定卫生系统特征的程度 增强伊迪的实效性。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，包括以下人群、医院和社区 最有可能从中受益。