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

项目摘要/摘要 医疗保险受益人的再次住院是频繁的、昂贵的，是效率低下和/或贫穷的指标 护理质量。老年患者特别容易再次入院。最近的政策变化，例如 建立医院再入院减少计划，惩罚有风险的医院- 调整后的再住院率高于全国平均水平，因此进一步重视减少这些 事件。出于这些原因，供应商和政策制定者已经做出了重大努力，以减少重新 住院率。实施电子健康记录(EHR)可能是一个有效的方法 减少重新入院人数。国家在企业人力资源方面进行了前所未有的投资， 约300亿美元可通过卫生信息技术促进经济和社会发展 2009年的《临床健康(HITECH)法案》。根据HITECH，财政奖励通过以下方式提供 有意义的使用，这要求参与的医院满足中心定义的某些目标 医疗保险和医疗补助服务。预计这些激励措施将使美国25%的医院 采用原本不会选择这样做的EHR，从而产生总体预期采用率 85%。电子病历促进了临床信息的获得，并与改善 护理的质量。如果这些质量改进降低了再次住院的可能性，作为早期证据 提示，EHR可能为降低再住院率提供了有效的干预措施。在这项研究中，我们将 首先，描述医院采用电子病历的模式。将特别关注以下医院 为不成比例的贫困患者提供服务，以检查以前记录的“数字鸿沟”是否 通过有意义的使用提供的激励措施持续存在或加剧。这将通过以下方式完成 回归分析以确定医院特征，如医疗补助出院比例， 与参与有意义的使用有关。然后，拟议的研究将提供EHR的证据 老年医疗保险受益人再住院率的影响。为了实现这一目标，有固定的效果 将进行回归分析，以量化医院参与 有意义的使用，以及在没有参与有意义的使用的情况下通过EHR，在30天内重新接纳 老年医疗保险受益人。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是 尤其有再次住院的风险。因此，使用具有双重资格的受益人样本，我们将评估 采用相同的分析方法分析医院采用电子病历对再住院的影响。结果是 这项研究将提供证据，证明美国通过对医疗保健的投资增加了医疗保健的价值 EHR。

PROJECT SUMMARY/ABSTRACT Re-hospitalization of Medicare beneficiaries is frequent, costly and is an indicator of inefficient and/or poor quality of care. Elderly patients are 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.