Understanding the Impact of Health Information Exchange-Enabled Care Plans to Coordinate Care among High-Need, High-Cost Patients

项目总结/摘要： 高需求，高成本的患者（HNHC）经常遇到护理协调不良，这是一个关键的驱动因素 增加成本和利用率。医疗保健组织和政策制定者正在投资于 将联合收割机健康信息交换与个性化 护理计划，以解决支离破碎的护理HNHC患者接受，但这些证据 方法有限。2012年，华盛顿州卫生保健管理局（HCA）， 监督州医疗补助计划，在全国范围内实施健康信息交换（HIE） 所有医院称为急诊科信息交流中心。作为HIE的一部分 实施，HCA为医院提供经济激励，以发展个性化护理 计划改善急诊科（艾德）高利用率（≥ 5次艾德访视）的护理协调 每年）。目前的项目旨在应用先进的定量方法， 推理，比较有效性和定性方法，以了解我们的差距， 了解使用HIE支持的护理计划，以改善HNHC的护理协调 患者为了完成这项研究，我将链接现有的华盛顿州医疗补助数据集 在EDIE中接受护理计划的患者。在健康专家的指导下工作 服务研究，我将：（1）衡量HIE支持的护理计划对医疗保健的影响 HNHC患者中的利用率（2）确定艾德较低的HNHC患者亚组 接受护理计划后的医疗保健利用率（3）描述了HIE护理的实施情况 HNHC患者的护理计划和内容。这些研究将告知医疗保健系统 改善复杂患者群体护理协调的方法。这项工作也将有助于 我建立了一套技能，成为一个独立的调查员，解决护理的差距 协调HNHC人群。

PROJECT SUMMARY/ABSTRACT: High-need, high-cost patients (HNHC) often experience poor coordination of care, a key driver of increased cost and utilization. Healthcare organizations and policymakers are investing in care coordination mechanisms that combine health information exchange with individualized care plans to fix the fragmented care HNHC patients receive, but evidence for these approaches is limited. In 2012, the Washington State Health Care Authority (HCA), which oversees the state Medicaid program, implemented a health information exchange (HIE) across all hospitals referred to as the Emergency Department Information Exchange. As part of HIE implementation, HCA provides financial incentives to hospitals to develop individualized care plans to improve care coordination for Emergency Department (ED) high utilizers (≥ 5 ED visits per year). The current project seeks to apply advanced quantitative methods in causal inference, comparative effectiveness, and qualitative methods to understand gaps in our knowledge in the use of HIE-enabled care plans to improve care coordination for HNHC patients. To accomplish this research, I will link an existing Washington State Medicaid dataset to patients who received a care plan in EDIE. Working under the mentorship of experts in health service research, I will: (1) measure the impact of HIE-supported care plans on healthcare utilization among HNHC patients (2) identify subgroups of HNHC patients with lower ED healthcare utilization after receipt of a care plan (3) describe the implementation of HIE-care plans and content of care plans in HNHC patients. These studies will inform healthcare systems on ways to improve care coordination for complex patient populations. This work will also help me establish a set of skills to become an independent investigator addressing the gaps in care coordination for HNHC populations.