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

医院采用电子病历和医疗保险受益人再住院

• 批准号: 8744262
• 负责人: Mark Aaron Unruh
• 金额: $ 8.48万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-30 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8744262
• 关键词: Adopted; Adoption; Caring; Characteristics; Charge; Clinical; Commit; Data; Data Sources; Economics; Elderly; Electronic Health Record; Ensure; Event; Goals; Health; Health Services; Healthcare; Hospitalization; Hospitals; Incentives; Inpatients; Investments; Lead; Measurement; Medicaid; Medicare; Medicare/Medicaid; Patients; Pattern; Policies; Population; Population Analysis; Provider; Quality of Care; Regression Analysis; Relative (related person); Reporting; Research; Risk; Sampling; Services; Site; Time; United States Centers for Medicare and Medicaid Services; Variant; beneficiary; cost; digital; dual eligible; effective intervention; experience; financial incentive; health care service utilization; health information technology; hospital readmission; improved; medically underserved; older patient; payment; pressure; programs; public health relevance

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.

描述（由申请人提供）：医疗保险受益人的再住院是频繁的，昂贵的，是效率低下和/或护理质量差的指标。老年患者特别容易再入院。最近的政策变化，如建立了医院再入院减少方案，对风险调整后再入院率高于国家平均水平的医院进行处罚，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已经做出了大量努力，以降低再住院率。实施电子健康记录（EHR）可能是减少再入院的有效方法。美国通过2009年《经济和临床健康卫生信息技术法案》（HITECH）向提供者提供约300亿美元，对EHR进行了前所未有的投资。根据HITECH，通过有意义的使用提供财务激励，这要求参与医院完成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使另外25%的美国医院采用EHR，否则这些医院不会选择这样做，从而使总体预期采用率达到85%。电子健康记录促进了临床信息的可用性，并与护理质量的改善有关。如果这些质量的提高降低了再住院的可能性，早期的证据表明，电子健康记录可能提供一个有效的干预措施，降低再住院率。在这项研究中，我们将首先描述医院之间的EHR采用模式。将特别关注为贫困患者提供服务的医院，以检查先前记录的“数字鸿沟”是否持续存在，或因有意义使用提供的激励措施而加剧。这将通过回归分析来完成，以确定与参与有意义使用相关的医院特征，例如医疗补助出院比例。这项拟议中的研究将提供EHR对老年医疗保险受益人再住院率影响的证据。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使用和采用EHR而不参与有意义使用之间的关系，对老年医疗保险受益人的30天再入院。参加Medicare和Medicaid的双重资格受益人可能面临再次住院的特殊风险。因此，我们将以双重合资格受益人为样本，采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。

项目成果

Hospital participation in Meaningful Use and racial disparities in readmissions.

医院参与有意义的使用和再入院的种族差异。

• 发表时间: 2018
• 期刊: The American journal of managed care
• 作者: Unruh,MarkAaron;Jung,HyeYoung;Kaushal,Rainu;Vest,JoshuaR
• 通讯作者: Vest,JoshuaR