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

描述（由申请人提供）：医疗保险受益人的再住院是频繁的，昂贵的，是一个低效率和/或低质量的医疗指标。老年患者尤其容易再入院。最近的政策变化，如医院减少再入院计划的建立，该计划对风险调整后再入院率高于全国平均水平的医院进行处罚，进一步重视减少这些事件。由于这些原因，医疗服务提供者和政策制定者已经投入了大量的努力来降低再住院率。实施电子健康记录（EHRs）可能是减少再入院的有效方法。国家在电子病历方面进行了前所未有的投资，通过2009年的经济和临床健康健康信息技术（HITECH）法案，为医疗服务提供者提供了大约300亿美元。在HITECH下，通过“有意义的使用”项目提供财政奖励，这要求参与的医院完成由医疗保险和医疗补助服务中心确定的某些目标。这些激励措施预计将导致另外25%的美国医院采用电子病历，否则这些医院不会选择这样做，从而使总体预期采用率达到85%。电子病历促进了临床信息的可用性，并与护理质量的提高有关。如早期证据所示，如果这些质量改善降低了再住院的可能性，电子病历可能是降低再住院率的有效干预措施。在本研究中，我们将首先描述医院采用电子病历的模式。将特别关注为不成比例的贫困患者提供服务的医院，以检查以前记录的“数字鸿沟”是否持续存在，或因“有意义使用”提供的激励而加剧。这将通过回归分析来确定医院的特征，例如与参与有意义使用相关的医疗补助出院比例。本研究将提供电子病历对老年医保受益人再住院率影响的证据。为了实现这一目标，我们将进行固定效应回归分析，量化医院参与有意义使用和采用没有参与有意义使用的电子病历对老年医疗保险受益人30天再入院的关系。同时参加医疗保险和医疗补助的双重资格受益人可能特别有再次住院的风险。因此，使用双重合格受益人的样本，我们将使用相同的分析方法评估医院采用电子病历对再住院的影响。研究结果将为美国在电子病历上的投资为医疗保健增加价值提供证据。

DESCRIPTION (provided by applicant): Re-hospitalization of Medicare beneficiaries is frequent, costly and is an indicator of inefficient and/or poor quality of care. Elderly patients ae 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.