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Boockvar KS, Koufacos NS, May J, Schwartzkopf AL, Guerrero VM, Judon KM, Schubert CC, Franzosa E, Dixon BE. Effect of Health Information Exchange Plus a Care Transitions Intervention on Post-Hospital Outcomes Among VA Primary Care Patients: a Randomized Clinical Trial. J Gen Intern Med 2022; 37:4054-4061. [PMID: 35199262 PMCID: PMC9708976 DOI: 10.1007/s11606-022-07397-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/04/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Health information exchange (HIE) notifications when patients experience cross-system acute care encounters offer an opportunity to provide timely transitions interventions to improve care across systems. OBJECTIVE To compare HIE notification followed by a post-hospital care transitions intervention (CTI) with HIE notification alone. DESIGN Cluster-randomized controlled trial with group assignment by primary care team. PATIENTS Veterans 65 or older who received primary care at 2 VA facilities who consented to HIE and had a non-VA hospital admission or emergency department visit between 2016 and 2019. INTERVENTIONS For all subjects, real-time HIE notification of the non-VA acute care encounter was sent to the VA primary care provider. Subjects assigned to HIE plus CTI received home visits and telephone calls from a VA social worker for 30 days after arrival home, focused on patient activation, medication and condition knowledge, patient-centered record-keeping, and follow-up. MEASURES Primary outcome: 90-day hospital admission or readmission. SECONDARY OUTCOMES emergency department visits, timely VA primary care team telephone and in-person follow-up, patients' understanding of their condition(s) and medication(s) using the Care Transitions Measure, and high-risk medication discrepancies. KEY RESULTS A total of 347 non-VA acute care encounters were included and assigned: 159 to HIE plus CTI and 188 to HIE alone. Veterans were 76.9 years old on average, 98.5% male, 67.8% White, 17.1% Black, and 15.1% other (including Hispanic). There was no difference in 90-day hospital admission or readmission between the HIE-plus-CTI and HIE-alone groups (25.8% vs. 20.2%, respectively; risk diff 5.6%; 95% CI - 3.3 to 14.5%, p = .25). There was also no difference in secondary outcomes. CONCLUSIONS A care transitions intervention did not improve outcomes for veterans after a non-VA acute care encounter, as compared with HIE notification alone. Additional research is warranted to identify transitions services across systems that are implementable and could improve outcomes.
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Affiliation(s)
- Kenneth S Boockvar
- James J. Peters VA Medical Center, Geriatrics Research Education & Clinical Center, Bronx, NY, 10468, USA.
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- The New Jewish Home, New York, NY, USA.
| | - Nicholas S Koufacos
- James J. Peters VA Medical Center, Geriatrics Research Education & Clinical Center, Bronx, NY, 10468, USA
| | - Justine May
- Richard L. Roudebush VA Medical Center, Center for Health Information and Communication, Indianapolis, IN, USA
| | - Ashley L Schwartzkopf
- Richard L. Roudebush VA Medical Center, Center for Health Information and Communication, Indianapolis, IN, USA
| | - Vivian M Guerrero
- James J. Peters VA Medical Center, Geriatrics Research Education & Clinical Center, Bronx, NY, 10468, USA
| | - Kimberly M Judon
- James J. Peters VA Medical Center, Geriatrics Research Education & Clinical Center, Bronx, NY, 10468, USA
| | - Cathy C Schubert
- Richard L. Roudebush VA Medical Center, Center for Health Information and Communication, Indianapolis, IN, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Emily Franzosa
- James J. Peters VA Medical Center, Geriatrics Research Education & Clinical Center, Bronx, NY, 10468, USA
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brian E Dixon
- Richard L. Roudebush VA Medical Center, Center for Health Information and Communication, Indianapolis, IN, USA
- Department of Epidemiology, Indiana University Fairbanks School of Public Health, Indianapolis, IN, USA
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
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Martin TR, Gasoyan H, Pirrotta G, Mathew R. A NATIONAL SURVEY ASSESSING HEALTH INFORMATION EXCHANGE: READINESS FOR CHANGES TO VETERANS AFFAIRS ACCESS STANDARDS. PERSPECTIVES IN HEALTH INFORMATION MANAGEMENT 2021; 18:1i. [PMID: 34858121 PMCID: PMC8580464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
We conducted a national survey of Health Information Exchanges (HIEs), targeting both not-for profit geographic and enterprise or federated exchanges. The aim of this study is to identify current best practices when exchanging information between Veterans Affairs (VA) systems and non-VA health systems. We identified and classified current interactions between HIEs and VA systems given recent passage of the MISSION Act. The MISSION Act allows veterans to seek care outside the VA health system, necessitating the need to reconcile care planning between VA systems and private care settings. We identified several differing best practices concerning information exchange between VA health systems and HIEs and assessed capabilities for HIEs to appropriately identify eligible VA participants within extant databases.
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Turvey CL, Klein DM, Nazi KM, Haidary ST, Bouhaddou O, Hsing N, Donahue M. Racial differences in patient consent policy preferences for electronic health information exchange. J Am Med Inform Assoc 2021; 27:717-725. [PMID: 32150259 DOI: 10.1093/jamia/ocaa012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/07/2020] [Accepted: 02/25/2020] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE This study aimed to explore the association between demographic variables, such as race and gender, and patient consent policy preferences for health information exchange as well as self-report by VHA enrollees of information continuity between Veterans Health Administration (VHA) and community non-VHA heath care providers. MATERIALS AND METHODS Data were collected between March 25, 2016 and August 22, 2016 in an online survey of 19 567 veterans. Three questions from the 2016 Commonwealth Fund International Health Policy Survey, which addressed care continuity, were included. The survey also included questions about consent policy preference regarding opt-out, opt-in, and "break the glass" consent policies. RESULTS VHA enrollees had comparable proportions of unnecessary laboratory testing and conflicting information from providers when compared with the United States sample in the Commonwealth Survey. However, they endorsed medical record information being unavailable between organizations more highly. Demographic variables were associated with gaps in care continuity as well as consent policy preferences, with 56.8% of Whites preferring an opt-out policy as compared with 40.3% of Blacks, 44.9% of Hispanic Latinos, 48.3% of Asian/Pacific Islanders, and 38.3% of Native Americans (P < .001). DISCUSSION Observed large differences by race and ethnicity in privacy preferences for electronic health information exchange should inform implementation of these programs to ensure cultural sensitivity. Veterans experienced care continuity comparable to a general United States sample, except for less effective exchange of health records between heath care organizations. VHA followed an opt-in consent policy at the time of this survey which may underlie this gap.
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Affiliation(s)
- Carolyn L Turvey
- labelVirtual Specialty Care QUERI Program: Implementing and Evaluating Technology Facilitated Clinical Interventions to Improve Access to High Quality Specialty Care for Rural Veterans, Seattle, Washington & Iowa City, Iowa, USA.,VA Office of Rural Health, Rural Health Resource Center, Iowa City, Iowa, USA.,Iowa City VA Health Care System, Comprehensive Access and Delivery Research and Evaluation Center, Iowa City, Iowa, USA.,Department of Psychiatry, The University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Dawn M Klein
- VA Office of Rural Health, Rural Health Resource Center, Iowa City, Iowa, USA.,Iowa City VA Health Care System, Comprehensive Access and Delivery Research and Evaluation Center, Iowa City, Iowa, USA.,Department of Psychiatry, The University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,J P Systems, Clifton, Virginia, USA
| | - Kim M Nazi
- Independent Information Technology Consultant, Coxsackie, New York, USA
| | - Susan T Haidary
- Veterans and Consumers Health Informatics Office, Office of Connected Care, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, USA
| | - Omar Bouhaddou
- US Department of Veterans Affairs, Veterans Health Information Exchange Program, Washington, DC.,innoVet Health, San Diego, California, USA
| | - Nelson Hsing
- US Department of Veterans Affairs, Veterans Health Information Exchange Program, Washington, DC
| | - Margaret Donahue
- US Department of Veterans Affairs, Veterans Health Information Exchange Program, Washington, DC
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Dixon BE, Luckhurst C, Haggstrom DA. Leadership Perspectives on Implementing Health Information Exchange: Qualitative Study in a Tertiary Veterans Affairs Medical Center. JMIR Med Inform 2021; 9:e19249. [PMID: 33616542 PMCID: PMC7939932 DOI: 10.2196/19249] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 08/15/2020] [Accepted: 12/04/2020] [Indexed: 11/21/2022] Open
Abstract
Background The US Department of Veterans Affairs (VA) seeks to achieve interoperability with other organizations, including non-VA community and regional health information exchanges (HIEs). Objective This study aims to understand the perspectives of leaders involved in implementing information exchange between VA and non-VA providers via a community HIE. Methods We interviewed operational, clinical, and information technology leaders at one VA facility and its community HIE partner. Respondents discussed their experiences with VA-HIE, including barriers and facilitators to implementation, and the associated impact on health care providers. Transcribed interviews were coded and analyzed using immersion-crystallization methods. Results VA and community HIE leaders found training to be a key factor when implementing VA-HIE and worked cooperatively to provide several styles and locations of training. During recruitment, a high-touch approach was successfully used to enroll patients and overcome their resistance to opting in. Discussion with leaders revealed the high levels of complexity navigated by VA providers and staff to send and retrieve information. Part of the complexity stemmed from the interconnected web of information systems and human teams necessary to implement VA-HIE information sharing. These interrelationships must be effectively managed to guide organizational decision making. Conclusions Organizational leaders perceived information sharing to be of essential value in delivering high-quality, coordinated health care. The VA continues to increase access to outside care through the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act. Along with this increase in non-VA medical care, there is a need for greater information sharing between VA and non-VA health care organizations. Insights by leaders into barriers and facilitators to VA-HIE can be applied by other national and regional networks that seek to achieve interoperability across health care delivery systems.
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Affiliation(s)
- Brian E Dixon
- VA HSR&D Center for Health Information and Communication, Richard L Roudebush Veterans Affairs Medical Center, Indianapolis, IN, United States.,Department of Epidemiology, Indiana University Richard M Fairbanks School of Public Health, Indianapolis, IN, United States.,Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, United States
| | - Cherie Luckhurst
- VA HSR&D Center for Health Information and Communication, Richard L Roudebush Veterans Affairs Medical Center, Indianapolis, IN, United States.,Orthopaedic Surgery Research, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, United States
| | - David A Haggstrom
- VA HSR&D Center for Health Information and Communication, Richard L Roudebush Veterans Affairs Medical Center, Indianapolis, IN, United States.,Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN, United States.,Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, United States
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5
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Lira LL, Chandrasekar J. The State of Research in Veterans Studies: A Systematic Literature Review. JOURNAL OF VETERANS STUDIES 2020. [DOI: 10.21061/jvs.v6i2.191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Ward R, Weeda ER, Bishu KG, Axon RN, Taber DJ, Gebregziabher M. An Evaluation of Statin Use Among Patients with Type 2 Diabetes at High Risk of Cardiovascular Events Across Multiple Health Care Systems. J Manag Care Spec Pharm 2020; 26:1090-1098. [PMID: 32857659 PMCID: PMC8819482 DOI: 10.18553/jmcp.2020.26.9.1090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Patients with more than one chronic condition often receive care from several providers and facilities, which may lead to fragmentation of care. Poor care coordination in dual health care system use has been associated with increased emergency department visits, hospitalizations, and costs. OBJECTIVE Dual health care system use is increasing among veterans, and we sought to evaluate the effect of dual health care system use on statin treatment in veterans with type 2 diabetes at high risk of cardiovascular events, using varying degrees of Centers for Medicare & Medicaid Services (CMS) services. METHODS This was a 10-year retrospective longitudinal cohort study of national clinical and administrative data that included 689,138 veterans with type 2 diabetes who were aged 65 years or older on January 1, 2006. Patients were followed from January 1, 2007, until December 31, 2016. Administrative and clinical data from the Veterans Health Administration's (VHA) Corporate Data Warehouse were merged with CMS inpatient, outpatient, and pharmacy data. Statin use was defined as any therapy and subcategorized as high versus low or moderate intensity per the American College of Cardiology/American Heart Association guidelines. Marginal generalized estimating equation-type models for longitudinal data were used to model the association between dual health care utilization status (< 50%, 50%-80%, and > 80% VHA utilization, with the first group serving as the reference group) and statin use after adjusting for measured covariates. RESULTS The mean ages at baseline for each group were similar and ranged between 75.4 and 76.9 years. For the outcome of any statin use, the group with < 50% VHA utilization was significantly less likely to receive statin therapy compared with the group with > 80% VHA utilization (OR = 0.26, 95% CI = 0.26-0.26), while the group with 50%-80% VHA utilization was slightly more likely (OR = 1.05, 95% CI = 1.04-1.07). Similarly, for the high-intensity versus low-/moderate-intensity or no statins outcome, the group with < 50% VHA utilization was significantly less likely to receive a high-intensity statin compared with the group with > 80% VHA utilization (OR = 0.56, 95% CI = 0.55-0.57), while the group with 50%-80% VHA utilization was only slightly less likely (OR = 0.95, 95% CI =0.94-0.96). CONCLUSIONS Among veterans with diabetes at high risk of cardiovascular events, dual health care system utilization status appeared to affect statin use. We observed lower odds for any statin use and high-intensity statin therapy among the cohort with the lowest degree of VHA utilization (i.e., < 50%). Interventions to increase statin use among veterans at high risk of cardiovascular events with lower degrees of VHA utilization should be explored. DISCLOSURES This study was supported by a grant funded by the Department of Veterans Affairs' Health Services Research and Development Service and was undertaken at the Health Equity and Rural Outreach Center (HEROIC) at Ralph H. Johnson Veteran Affairs Medical Center, Charleston, SC. The authors report no potential conflicts of interest relevant to this article. This article represents the views of the authors and not those of the Medical University of South Carolina or Veteran Health Administration.
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Affiliation(s)
- Ralph Ward
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina, and Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston
| | - Erin R. Weeda
- Department of Clinical Pharmacy and Outcome Sciences, College of Pharmacy, Medical University of South Carolina, Charleston
| | - Kinfe G. Bishu
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina
| | - R. Neal Axon
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina, and Department of Medicine, College of Medicine, Medical University of South Carolina, Charleston
| | - David J. Taber
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina, and Department of Surgery, College of Medicine, Medical University of South Carolina, Charleston
| | - Mulugeta Gebregziabher
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina, and Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston
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7
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Wu AM, Wu CM, Tseng VL, Greenberg PB, Giaconi JA, Yu F, Lum F, Coleman AL. Characteristics Associated With Receiving Cataract Surgery in the US Medicare and Veterans Health Administration Populations. JAMA Ophthalmol 2019; 136:738-745. [PMID: 29800973 DOI: 10.1001/jamaophthalmol.2018.1361] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Considerable variation exists with respect to the profiles of patients who receive cataract surgery in the United States. Objective To identify patient characteristics associated with receiving cataract surgery within the US Medicare and Veterans Health Administration (VHA) populations. Design, Setting, and Participants In this population-based retrospective cohort study of 3 073 465 patients, Medicare and VHA patients with a cataract diagnosis between January 1, 2002, and January 1, 2012, were identified from the 2002-2012 Medicare Part B files (5% sample) and the VHA National Patient Care Database. Patient age, sex, race/ethnicity, region of residence, Charlson Comorbidity Index (CCI) scores, and comorbidities were recorded. Cataract surgery at 1 and 5 years after diagnosis was identified. Data analysis was performed from July 1, 2016, to July 1, 2017. Main Outcomes and Measures Odds ratios (ORs) of cataract surgery for selected patient characteristics. Results The study sample included 1 156 211 Medicare patients (mean [SD] age, 73.7 [7.0] years) and 1 917 254 VHA patients (mean [SD] age, 66.8 [10.2] years) with a cataract diagnosis. Of the 1 156 211 Medicare patients, 407 103 (35.2%) were 65 to 69 years old, 683 036 (59.1%) were female, and 1 012 670 (87.6%) were white. Of the 1 917 254 VHA patients, 905 455 (47.2%) were younger than 65 years, 1 852 158 (96.6%) were male, and 539 569 (28.1%) were white. A greater proportion of Medicare patients underwent cataract surgery at 1 year (Medicare: 213 589 [18.5%]; VHA: 120 196 [6.3%]) and 5 years (Medicare: 414 586 [35.9%]; VHA: 240 884 [12.6%]) after diagnosis. Factors associated with the greatest odds of surgery at 5 years were older age per 5-year increase (Medicare: OR, 1.24 [95% CI, 1.23-1.24]; VHA: OR, 1.18 [95% CI, 1.17-1.18]), residence in the southern United States vs eastern United States (Medicare: OR, 1.38 [95% CI, 1.36-1.40]; VHA: OR, 1.40 [95% CI, 1.38-1.41]), and presence of chronic pulmonary disease (Medicare: OR, 1.26 [95% CI, 1.24-1.27]; VHA: OR, 1.40 [95% CI, 1.38-1.41]). Within Medicare, female sex was associated with greater odds of surgery at 5 years (OR, 1.14; 95% CI, 1.13-1.15). Higher CCI scores (CCI score ≥3 vs 0-2) were associated with increased odds of surgery among VHA but not Medicare patients at 5 years (Medicare: OR, 0.94 [95% CI, 0.92-0.95]; VHA: OR, 1.24 [95% CI, 1.23-1.36]). Black race vs white race was associated with decreased odds of cataract surgery 5 years after diagnosis (Medicare: OR, 0.79 [95% CI, 0.78-0.81]; VHA: OR, 0.75 [95% CI, 0.73-0.76]). Conclusions and Relevance Within both groups, older age, residence in the southern United States, and presence of chronic pulmonary disease were associated with increased odds of cataract surgery. Findings from this study suggest that few disparities exist between the types of patients receiving cataract surgery who are in Medicare vs the VHA, although it is possible that a smaller proportion of VHA patients receive surgery compared with Medicare patients.
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Affiliation(s)
- Annie M Wu
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Connie M Wu
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Victoria L Tseng
- Stein Eye Institute, David Geffen School of Medicine, UCLA (University of California, Los Angeles).,Department of Epidemiology, Fielding School of Public Health, UCLA
| | - Paul B Greenberg
- Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Section of Ophthalmology, Veterans Affairs Medical Center, Providence, Rhode Island
| | - JoAnn A Giaconi
- Stein Eye Institute, David Geffen School of Medicine, UCLA (University of California, Los Angeles).,Ophthalmology Division, West Los Angeles Veterans Affairs Medical Center, Los Angeles, California
| | - Fei Yu
- Department of Epidemiology, Fielding School of Public Health, UCLA.,Department of Biostatistics, Fielding School of Public Health, UCLA
| | - Flora Lum
- American Academy of Ophthalmology, San Francisco, California
| | - Anne L Coleman
- Stein Eye Institute, David Geffen School of Medicine, UCLA (University of California, Los Angeles).,Department of Epidemiology, Fielding School of Public Health, UCLA.,Department of Biostatistics, Fielding School of Public Health, UCLA
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8
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Dixon BE, Schwartzkopf AL, Guerrero VM, May J, Koufacos NS, Bean AM, Penrod JD, Schubert CC, Boockvar KS. Regional data exchange to improve care for veterans after non-VA hospitalization: a randomized controlled trial. BMC Med Inform Decis Mak 2019; 19:125. [PMID: 31272427 PMCID: PMC6611045 DOI: 10.1186/s12911-019-0849-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 06/24/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Coordination of care, especially after a patient experiences an acute care event, is a challenge for many health systems. Event notification is a form of health information exchange (HIE) which has the potential to support care coordination by alerting primary care providers when a patient experiences an acute care event. While promising, there exists little evidence on the impact of event notification in support of reengagement into primary care. The objectives of this study are to 1) examine the effectiveness of event notification on health outcomes for older adults who experience acute care events, and 2) compare approaches to how providers respond to event notifications. METHODS In a cluster randomized trial conducted across two medical centers within the U.S. Veterans Health Administration (VHA) system, we plan to enroll older patients (≥ 65 years of age) who utilize both VHA and non-VHA providers. Patients will be enrolled into one of three arms: 1) usual care; 2) event notifications only; or 3) event notifications plus a care transitions intervention. In the event notification arms, following a non-VHA acute care encounter, an HIE-based intervention will send an event notification to VHA providers. Patients in the event notification plus care transitions arm will also receive 30 days of care transition support from a social worker. The primary outcome measure is 90-day readmission rate. Secondary outcomes will be high risk medication discrepancies as well as care transitions processes within the VHA health system. Qualitative assessments of the intervention will inform VHA system-wide implementation. DISCUSSION While HIE has been evaluated in other contexts, little evidence exists on HIE-enabled event notification interventions. Furthermore, this trial offers the opportunity to examine the use of event notifications that trigger a care transitions intervention to further support coordination of care. TRIAL REGISTRATION ClinicalTrials.gov NCT02689076. "Regional Data Exchange to Improve Care for Veterans After Non-VA Hospitalization." Registered 23 February 2016.
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Affiliation(s)
- Brian E. Dixon
- Department of Veterans Affairs, Health Services Research & Development Service, Center for Health Information and Communication, 1481 W. 10th St, 11H, Indianapolis, IN 46202 USA
- Indiana University, Fairbanks School of Public Health, 1050 Wishard Blvd, Indianapolis, IN 46202 USA
- Regenstrief Institute, Center for Biomedical Informatics, 1101 W 10th St, Indianapolis, IN 46202 USA
| | - Ashley L. Schwartzkopf
- Department of Veterans Affairs, Health Services Research & Development Service, Center for Health Information and Communication, 1481 W. 10th St, 11H, Indianapolis, IN 46202 USA
| | - Vivian M. Guerrero
- Department of Veterans Affairs, James J. Peters VA Medical Center, 130 W Kingsbridge Rd, Bronx, NY 10468 USA
| | - Justine May
- Department of Veterans Affairs, Health Services Research & Development Service, Center for Health Information and Communication, 1481 W. 10th St, 11H, Indianapolis, IN 46202 USA
| | - Nicholas S. Koufacos
- Department of Veterans Affairs, James J. Peters VA Medical Center, 130 W Kingsbridge Rd, Bronx, NY 10468 USA
| | - Andrew M. Bean
- Department of Veterans Affairs, James J. Peters VA Medical Center, 130 W Kingsbridge Rd, Bronx, NY 10468 USA
| | - Joan D. Penrod
- Department of Veterans Affairs, James J. Peters VA Medical Center, 130 W Kingsbridge Rd, Bronx, NY 10468 USA
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029 USA
| | - Cathy C. Schubert
- Department of Veterans Affairs, Health Services Research & Development Service, Center for Health Information and Communication, 1481 W. 10th St, 11H, Indianapolis, IN 46202 USA
- Indiana University, School of Medicine, 1101 W. 10th St, Indianapolis, IN 46202 USA
| | - Kenneth S. Boockvar
- Department of Veterans Affairs, James J. Peters VA Medical Center, 130 W Kingsbridge Rd, Bronx, NY 10468 USA
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029 USA
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Mattocks KM, Cunningham K, Elwy AR, Finley EP, Greenstone C, Mengeling MA, Pizer SD, Vanneman ME, Weiner M, Bastian LA. Recommendations for the Evaluation of Cross-System Care Coordination from the VA State-of-the-art Working Group on VA/Non-VA Care. J Gen Intern Med 2019; 34:18-23. [PMID: 31098968 PMCID: PMC6542862 DOI: 10.1007/s11606-019-04972-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In response to widespread concerns regarding Veterans' access to VA care, Congress enacted the Veterans Access, Choice and Accountability Act of 2014, which required VA to establish the Veterans Choice Program (VCP). Since the inception of VCP, more than two million Veterans have received care from community providers, representing approximately 25% of Veterans enrolled in VA care. However, expanded access to non-VA care has created challenges in care coordination between VA and community health systems. In March 2018, the VA Health Services Research & Development Service hosted a VA State of the Art conference (SOTA) focused on care coordination. The SOTA convened VA researchers, program directors, clinicians, and policy makers to identify knowledge gaps regarding care coordination within the VA and between VA and community systems of care. This article provides a summary and synthesis of relevant literature and provides recommendations generated from the SOTA about how to evaluate cross-system care coordination. Care coordination is typically evaluated using health outcomes including hospital readmissions and death; however, in cross-system evaluations of care coordination, measures such as access, cost, Veteran/patient and provider satisfaction (including with cross-system communication), comparable quality metrics, context (urban vs. rural), and patient complexity (medical and mental health conditions) need to be included to fully evaluate care coordination effectiveness. Future research should examine the role of multiple individuals coordinating VA and non-VA care, and how these coordinators work together to optimize coordination.
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Affiliation(s)
- Kristin M Mattocks
- VA Central Western Massachusetts Healthcare System, Leeds, MA, USA. .,Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
| | | | - A Rani Elwy
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA.,Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA
| | - Erin P Finley
- South Texas Veterans Health Care System, San Antonio, TX, USA.,University of Texas Health Science Center, San Antonio, TX, USA
| | - Clinton Greenstone
- VHA Office of Community Care, Washington, DC, USA.,University of Michigan Medical School, Ann Arbor, MI, USA
| | - Michelle A Mengeling
- The Center for Comprehensive Access & Delivery Research and Evaluation (CADRE) and VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City VA Health Care System, Iowa City, IA, USA.,Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Steven D Pizer
- VA Boston Healthcare System, Boston, MA, USA.,Boston University School of Public Health, Boston, MA, USA
| | - Megan E Vanneman
- Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,Department of Internal Medicine/Division of Epidemiology & Department of Population Health Sciences/Division of Health System Innovation and Research, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Michael Weiner
- VA Health Services Research and Development Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA.,Regenstrief Institute, Inc., Indianapolis, IN, USA.,Center for Health Services and Outcomes Research, Indiana University, Indianapolis, IN, USA
| | - Lori A Bastian
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.,Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA
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Schinasi LH, Auchincloss AH, Forrest CB, Diez Roux AV. Using electronic health record data for environmental and place based population health research: a systematic review. Ann Epidemiol 2018; 28:493-502. [PMID: 29628285 DOI: 10.1016/j.annepidem.2018.03.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 03/13/2018] [Accepted: 03/16/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE We conducted a systematic review of literature published on January 2000-May 2017 that spatially linked electronic health record (EHR) data with environmental information for population health research. METHODS We abstracted information on the environmental and health outcome variables and the methods and data sources used. RESULTS The automated search yielded 669 articles; 128 articles are included in the full review. The number of articles increased by publication year; the majority (80%) were from the United States, and the mean sample size was approximately 160,000. Most articles used cross-sectional (44%) or longitudinal (40%) designs. Common outcomes were health care utilization (32%), cardiometabolic conditions/obesity (23%), and asthma/respiratory conditions (10%). Common environmental variables were sociodemographic measures (42%), proximity to medical facilities (15%), and built environment and land use (13%). The most common spatial identifiers were administrative units (59%), such as census tracts. Residential addresses were also commonly used to assign point locations, or to calculate distances or buffer areas. CONCLUSIONS Future research should include more detailed descriptions of methods used to geocode addresses, focus on a broader array of health outcomes, and describe linkage methods. Studies should also explore using longitudinal residential address histories to evaluate associations between time-varying environmental variables and health outcomes.
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Affiliation(s)
- Leah H Schinasi
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA; Urban Health Collaborative, Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA.
| | - Amy H Auchincloss
- Urban Health Collaborative, Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | | | - Ana V Diez Roux
- Urban Health Collaborative, Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA
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