HIE and Ambulatory Test Utilization

描述(由申请人提供)：为了实现高质量的医疗保健系统，医疗提供者需要随时获得可操作的健康信息。我们当前系统中的医疗保健支离破碎导致信息缺失，导致效率低下和次优的医疗决策。通过提供自由的信息流动，电子健康信息交换(HIE)是提高医疗效率和质量的一种很有前途的方法。如果HIE的效率提高(如减少重复和不必要的检测)，可能会激励医疗支付者补贴HIE的努力，以改善更广泛的卫生保健系统。然而，目前关于HIE降低测试利用率的证据很少，也没有定论。科罗拉多州梅萨县为更明确地评估HIE的影响提供了丰富的资源。质量健康网络于2005年开始向梅萨县提供HIE，几乎捕获了该县所有的检测结果，已被351多名从业者(超过85%的县从业者)采用。也有证据表明，自引进HIE以来，梅萨县实验室和放射科使用率的下降与全国稳定或增加测试使用率的趋势形成对比。这项研究将正式评估采用HIE是否与梅萨县减少实验室和放射学检测的使用有关。它还将评估HIE的影响是否在护理更加分散的情况下(患者从多个诊所接受护理的情况)更加明显。结合质量健康网络的实践水平信息和该地区主要商业健康计划2004年至2009年的索赔数据，将使用差异差异模型来区分采用HIE的影响和测试利用的长期趋势。这项研究的结果将指导未来的HIE努力，并将提供对HIE国家决策者和当地利益攸关方有用的价值估计。其目标直接关系到AHRQ对HIE项目的投资，以及AHRQ促进和评估卫生信息技术的使用以提高医疗质量和效率的总体使命。 公共卫生相关性：社区卫生信息的电子交换可能提高医疗保健的质量和效率。当他们需要的健康信息近在咫尺时，医生可以做出更好的决定。通过评估强大、成熟的区域卫生信息交流系统是否有助于医生提供更有效的医疗服务，该项目将向地方和国家利益攸关方通报卫生信息交流努力。

DESCRIPTION (provided by applicant): To achieve a high-quality health care system, medical providers need ready access to actionable health information. Fragmentation of care in our current system results in missing information, leading to inefficiencies and suboptimal medical decision making. By providing a free flow of information, electronic health information exchange (HIE) is a promising method for improving the efficiency and quality of care. If efficiency gains from HIE (such as a reduction in duplicative and unnecessary testing) can be established, it may motivate medical payers to subsidize HIE efforts that improve the health care system more broadly. Current evidence that HIE reduces test utilization is, however, scant and inconclusive. Mesa County, Colorado provides a rich resource for more definitive assessment of the effects of HIE. Quality Health Network started providing HIE to Mesa County in 2005, captures nearly all the test results in the County, and has been adopted by over 351 practitioners (over 85% of County practitioners). There is also evidence that reductions in laboratory and radiology utilization since the introduction HIE in Mesa County contrast with national trends of steady or increasing test utilization. This study will formally assess whether adoption of HIE is associated with a reduction in utilization of laboratory and radiology testing in Mesa County. It will also assess whether the effects of HIE are more pronounced in when care is more fragmented (circumstances in which patients receive care from more than one practice). Combining practice-level information from Quality Health Network and claims data from 2004 through 2009 from the primary commercial health plan in the area, a differences-in-differences model will be employed to distinguish the effects of HIE adoption from secular trends in test utilization. The results of this study will guide future HIE efforts, and will provide estimates of value that will prove useful for national decision makers and local stakeholders in HIE. Its goals are directly relevant to AHRQ's investments in HIE projects, and AHRQ's general mission to promote and assess the use of health information technology to improve healthcare quality and efficiency. PUBLIC HEALTH RELEVANCE: The electronic exchange of health information in communities may improve the quality and efficiency of medical care. Doctors can make better decisions when the health information they need is at hand. By assessing whether a robust, mature regional health information exchange system helped doctors provide more efficient medical care, this project will inform local and national stakeholders in health information exchange efforts.