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

描述(由申请人提供)：医疗保险受益人再次住院的频率高、费用高，是医疗效率低下和/或护理质量差的一个指标。老年患者特别容易再次入院。最近的政策变化，如建立了医院再入院减少方案，惩罚风险调整后再住院率高于全国平均水平的医院，进一步重视减少这些事件。出于这些原因，医疗服务提供者和政策制定者作出了大量努力，以降低再住院率。实施电子健康记录(EHR)可能是减少重新入院的有效方法。美国通过2009年《卫生信息技术促进经济和临床卫生法案》(HITECH)向医疗服务提供者提供了约300亿美元，对EHR进行了前所未有的投资。根据HITECH，财政激励是通过有意义的使用来提供的，这要求参与其中的医院实现医疗保险和医疗补助服务中心定义的某些目标。这些激励措施预计将导致另外25%的美国医院采用EHR，否则这些医院不会选择这样做，从而导致总体预期采用率为85%。电子病历促进了临床信息的可获得性，并与护理质量的改善有关。如果这些质量改进降低了再住院的可能性，正如早期证据所表明的那样，EHR可能会为降低再住院率提供有效的干预措施。在这项研究中，我们将首先描述医院采用电子病历的模式。将特别关注那些为贫困患者提供不成比例服务的医院，以检查以前记录的“数字鸿沟”是否持续存在，或者通过有意义的使用提供的激励措施是否加剧了这种鸿沟。这将通过回归分析来确定与参与有意义的使用有关的医院特征，如医疗补助出院比例。然后，拟议的研究将提供证据，证明EHR对老年医疗保险受益人的再住院率的影响。为了实现这一目标，将进行固定效应回归分析，以量化医院参与有意义的使用与采用电子病历而不参与有意义的使用之间的关系，这与老年医疗保险受益人30天的再入院时间之间的关系。同时参加联邦医疗保险和医疗补助的双重资格受益人可能特别有可能再次住院。因此，我们将以符合双重资格的受益人为样本，使用相同的分析方法评估医院采用电子健康记录对再次住院的影响。这项研究的结果将提供证据，证明美国通过对EHR的投资为医疗保健增加了价值。

DESCRIPTION (provided by applicant): Re-hospitalization of Medicare beneficiaries is frequent, costly and is an indicator of inefficient and/or poor quality of care. Elderly patients ae 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.