Advancing Quality Measurement and Care Improvement with Health Information Exchan

描述（由申请人提供）：本申请的目标是创建和验证两个拟议的国家质量论坛（NQF）电子质量措施的健康信息交换（HIE）启用版本，用于潜在可预防的急诊科（艾德）访视：1）在72小时内返回艾德（艾德回报）和2）频繁的艾德用户，然后评估他们的影响，目前只使用“筒仓艾德”机构的具体数据的干预措施。该项目将与纽约临床信息交换（NYCLIX）一起实施，NYCLIX是一个现有的HIE，涵盖纽约市（NYC）的大多数主要医院。 目前质量衡量方法的一个局限性是，它通常是针对具体机构的，仅限于单个提供者组织。HIE的出现提供了一个以新的方式思考质量的机会，并创造了新的以患者为中心的质量措施，这些措施可以在患者寻求护理的任何地方收集数据。 本申请中的具体假设是：1）启用HIE的电子质量措施将允许更好地检测艾德质量保证（QA）病例和频繁的艾德用户，2）在正在进行的项目中使用这些措施将改善艾德QA流程并减少频繁的艾德用户的访问次数。 该项目的目标是：1）开发和验证基于健康信息交换的工具，以支持针对艾德退货和频繁使用艾德的新机构间电子质量措施，2）用定量和定性方法比较新的机构间电子质量措施与当前特定地点措施的绩效; 3）实施新的机构间电子质量措施，在现有的质量保证和案例管理程序中进行质量测量，并量化影响。 主要结局包括72小时返回和频繁艾德用户队列中采集的患者数量，包括新的机构间措施和未采用新的机构间措施。次要结果包括构成质量问题的72小时返回病例的数量，以及采用和不采用新的机构间措施的频繁艾德用户的访问数量。 公共卫生相关性：该项目将通过检测患者在一个研究中心首次艾德访视后72小时内在多个急诊科（ED）返回的时间，提供对个人在急诊科（ED）接受的护理质量的改进测量。72-小时回报被认为是首次访问时潜在质量问题的指标。该项目阿索将提供一种方法，以减少频繁使用者的艾德就诊，可能导致剩余人群的急诊室不那么拥挤。

DESCRIPTION (provided by applicant): The goal of this application is to create and validate health information exchange (HIE)-enabled versions of two proposed National Quality Forum (NQF) e-Quality measure for potentially preventable emergency department (ED) visits: 1) returns to the ED within 72 hours (ED returns) and 2) frequent ED users, then evaluate their impact on interventions currently using only "siloed" institution-specific data. The project will b implemented with the New York Clinical Information Exchange (NYCLIX), an existing HIE that spans most of the major hospitals in New York City (NYC). One limitation to the current approach to quality measurement is that it is usually institution- specific, limited to a single provider organization. The advent of HIE presents an opportunity to think about quality in new ways and create new patient-centric quality measures that gather data wherever patients seek care. The specific hypotheses in this application are that 1) HIE-enabled e-Quality measures will allow better detection of ED quality assurance (QA) cases and frequent ED users and 2) use of these measures in ongoing programs will improve ED QA processes and decrease the number of visits by frequent ED users. The Aims of this project are 1) Develop and validate a health information exchange-based tool to support new inter-institutional e-Quality measures for ED returns and frequent ED users, 2) Compare the performance of the new inter-institutional e-Quality measures to current site- specific measures with quantitative and qualitative methods and 3) Implement the new inter- institutional e-Quality measures in existing QA and case management programs and quantify the impact. The primary outcomes include the number of patients captured in the 72-hour return and frequent ED user cohorts with and without the new inter-institutional measures. Secondary outcomes include the number of 72-hour return cases constituting quality issues, and the number of visits by frequent ED users with and without the new inter-institutional measures. PUBLIC HEALTH RELEVANCE: This project will provide improved quality measurement of the care individuals receive in emergency departments (EDs) by detecting when patients return within 72- hours across numerous EDs following an initial ED visit at one site. 72-hour returns are considered an indicator of potential quality problems on the initial visit. This project will aso provide a means to decrease ED visits by frequent users, potentially leading to less crowded EDs for the remaining population.