Evaluation of VLER_Indiana Health Information Exchange Demonstration Project

描述（由申请人提供）： 背景资料：印第安纳波利斯VA和印第安纳州健康信息交换（IHIE）将通过VLER健康计划进行双向健康信息交换（HIE）。VA-IHIE计划将提供外部电子健康记录的退伍军人谁选择加入该计划，他们的VA和非VA提供者在护理点时，他们看到。关于HIE对医疗保健质量和成本的影响，经验上知之甚少。目标1：评估VA以外的退伍军人接受的卫生保健的比例和预测因素目的2：评估VA-IHIE对退伍军人接受的保健质量的影响“假设1：VA-IHIE的实施将提高退伍军人中的门诊保健质量“假设2：VA-IHIE的实施将降低退伍军人中门诊保健敏感状况的入院率“假设3：目的3：探讨VA-IHIE的实施是否会减少退伍军人医疗保健的经济支出研究人群：我们的研究人群是退伍军人患者，他们在印第安纳波利斯VA和与IHIE相关的非VA医疗机构就诊，因此有医疗保健信息可以交换。在实施组中，VA-IHIE计划将交付给2,000名退伍军人患者，他们在过去15个月里在印第安纳波利斯退伍军人管理局就诊。对照组将包括退伍军人管理局以外的其他医疗保健数据的退伍军人，他们的信息交换尚未激活。研究设计：将在印第安纳波利斯退伍军人管理局的退伍军人中进行VA-IHIE实施的前后评价，同时设对照组。我们将使用倾向评分方法模拟随机化，因为由于实施限制，患者将不会被随机分配至VA-IHIE激活。退伍军人接受护理的数据将在VA-IHIE入组前一年和入组后一年获得。数据将从VA和IHIE电子健康记录信息中提取。措施：我们将从（1）未充分使用门诊服务和（2）过度使用医学检查两个方面来衡量HIE对医疗保健质量的影响。鉴于过度使用措施普遍不发达，我们将召集一系列专家小组，以促进制定一套过度使用措施。最后，我们将衡量VA-IHIE实施前后的经济支出。我们将根据我们的概念框架测量可能影响VA-IHIE影响的潜在协变量。这些因素包括VA-IHIE访问（或HIE交易），提供者的相互依赖性（利用）和患者的复杂性（社会人口特征，疾病和合并症），以及VA之外可用的临床数据的数量和类型。

DESCRIPTION (provided by applicant): Background: The Indianapolis VA and Indiana Health Information Exchange (IHIE) will partner through the VLER HEALTH program to perform bi-directional health information exchange (HIE). The VA-IHIE program will deliver the outside electronic health records of Veterans who opt-in to the program to their VA and non-VA providers at the point of care when they are seen. Little is known empirically about the effect of HIE upon health care quality and cost. Aim 1: to assess the proportion and predictors of health care received by Veterans outside the VA Aim 2: to assess the impact of VA-IHIE upon the quality of care received by Veterans " Hypothesis 1: implementation of VA-IHIE will improve the quality of ambulatory care among Veterans " Hypothesis 2: implementation of VA-IHIE will reduce admission rates for ambulatory care sensitive conditions among Veterans " Hypothesis 3: implementation of VA-IHIE will reduce overuse of medical tests among Veterans Aim 3: to explore whether the implementation of VA-IHIE will reduce the economic expenditures of health care for Veterans Study Population: Our study population is Veteran patients who have been seen at both the Indianapolis VA and a non-VA medical institution associated with IHIE and, thus, have health care information to exchange. In the implementation group, the VA-IHIE program will be delivered to 2,000 Veteran patients who have been seen at the Indianapolis VA in the past 15 months. The control group will include Veterans with additional health care data outside the VA, for whom information exchange has not been activated. Study Design: A pre-post evaluation of the VA-IHIE implementation, with a concurrent control group, will be performed among Veterans seen at the Indianapolis VA. We will use a propensity score approach to mimic randomization since the patients will not be randomized to VA-IHIE activation due to implementation constraints. Data on care received by Veterans will be obtained for one year before, and one year after, VA-IHIE enrollment. Data will be drawn from VA and IHIE electronic health record information. Measures: We will measure the impact of HIE upon health care quality in terms of both the (1) underuse of ambulatory care services and (2) overuse of medical tests. Given that overuse measures are generally underdeveloped, we will convene a set of expert panels to facilitate the development of a set of overuse measures. Finally, we will measure economic expenditures before and after VA-IHIE implementation. We will measure potential covariates that may affect the impact of VA-IHIE based upon our conceptual framework. These factors include VA-IHIE access (or HIE transactions), provider interdependence (utilization), and patient complexity (sociodemographic characteristics, diseases, and comorbidity), as well the amount and type of clinical data available outside the VA.