Understanding the Impact of Health Information Exchange-Enabled Care Plans to Coordinate Care among High-Need, High-Cost Patients

项目摘要/摘要： 高需求、高成本患者(HNHC)经常经历糟糕的护理协调，这是一个关键驱动因素 增加了成本和利用率。医疗组织和政策制定者正在投资于 将卫生信息交流与个性化相结合的护理协调机制 CARE计划修复HNHC患者接受的零散医疗服务，但这些证据 方法是有限的。2012年，华盛顿州医疗保健管理局(HCA) 监督州医疗补助计划，实施医疗信息交换(HIE) 所有医院均称为急诊科信息交换中心。作为HIE的一部分 实施，医管局向医院提供财政激励，以发展个性化护理 计划改善急诊科(ED)高使用率患者的护理协调(≥5 ED访问 每年)。目前的项目试图将先进的量化方法应用于因果关系 推理、比较有效性和定性方法，以了解我们的差距 了解使用HIE支持的护理计划以改善HNHC的护理协调 病人。为了完成这项研究，我将链接华盛顿州现有的医疗补助数据集 给在伊迪接受护理计划的病人。在健康专家的指导下工作 服务研究，我将：(1)衡量HIE支持的护理计划对医疗保健的影响 HNHC患者的利用(2)识别边缘较低的HNHC患者亚群 收到护理计划后的医疗利用情况(3)描述HIE-CARE的实施情况 HNHC患者的护理计划及内容。这些研究将为医疗系统提供信息 关于如何改善复杂患者群体的护理协调。这项工作也将有所帮助 我建立了一套技能，成为一名独立的调查员，解决护理方面的差距 HNHC人群的协调。

PROJECT SUMMARY/ABSTRACT: High-need, high-cost patients (HNHC) often experience poor coordination of care, a key driver of increased cost and utilization. Healthcare organizations and policymakers are investing in care coordination mechanisms that combine health information exchange with individualized care plans to fix the fragmented care HNHC patients receive, but evidence for these approaches is limited. In 2012, the Washington State Health Care Authority (HCA), which oversees the state Medicaid program, implemented a health information exchange (HIE) across all hospitals referred to as the Emergency Department Information Exchange. As part of HIE implementation, HCA provides financial incentives to hospitals to develop individualized care plans to improve care coordination for Emergency Department (ED) high utilizers (≥ 5 ED visits per year). The current project seeks to apply advanced quantitative methods in causal inference, comparative effectiveness, and qualitative methods to understand gaps in our knowledge in the use of HIE-enabled care plans to improve care coordination for HNHC patients. To accomplish this research, I will link an existing Washington State Medicaid dataset to patients who received a care plan in EDIE. Working under the mentorship of experts in health service research, I will: (1) measure the impact of HIE-supported care plans on healthcare utilization among HNHC patients (2) identify subgroups of HNHC patients with lower ED healthcare utilization after receipt of a care plan (3) describe the implementation of HIE-care plans and content of care plans in HNHC patients. These studies will inform healthcare systems on ways to improve care coordination for complex patient populations. This work will also help me establish a set of skills to become an independent investigator addressing the gaps in care coordination for HNHC populations.