Association between 30-day readmission rates and health information technology capabilities in US hospitals

Abstract

Health information technology (IT) is often proposed as a solution to fragmentation of care, and has been hypothesized to reduce readmission risk through better information flow. However, there are numerous distinct health IT capabilities, and it is unclear which, if any, are associated with lower readmission risk. To identify the specific health IT capabilities adopted by hospitals that are associated with hospital-level risk-standardized readmission rates (RSRRs) through path analyses using structural equation modeling. This STROBE-compliant retrospective cross-sectional study included non-federal U.S. acute care hospitals, based on their adoption of specific types of health IT capabilities self-reported in a 2013 American Hospital Association IT survey as independent variables. The outcome measure included the 2014 RSRRs reported on Hospital Compare website. A 54-indicator 7-factor structure of hospital health IT capabilities was identified by exploratory factor analysis, and corroborated by confirmatory factor analysis. Subsequent path analysis using Structural equation modeling revealed that a one-point increase in the hospital adoption of patient engagement capability latent scores (median path coefficient ß = −0.086; 95% Confidence Interval, −0.162 to −0.008), including functionalities like direct access to the electronic health records, would generally lead to a decrease in RSRRs by 0.086%. However, computerized hospital discharge and information exchange capabilities with other inpatient and outpatient providers were not associated with readmission rates. These findings suggest that improving patient access to and use of their electronic health records may be helpful in improving hospital performance on readmission; however, computerized hospital discharge and information exchange among clinicians did not seem as beneficial – perhaps because of the quality or timeliness of information transmitted. Future research should use more recent data to study, not just adoption of health IT capabilities, but also whether their usage is associated with lower readmission risk. Understanding which capabilities impact readmission risk can help policymakers and clinical stakeholders better focus their scarce resources as they invest in health IT to improve care delivery.

Integration of patient experience factors improves readmission prediction

“…This is supported by several studies assessing satisfaction as a complex metric influenced by patient demographics and care interactions. [ 33 ] Exploratory factor analysis is considered “one of the strongest approaches for assessing construct validity [of an instrument],” [ 34 ] and has been previously utilized to assess clusters of survey questions relating to readmission prediction from a health IT survey [ 35 ] as well as to composite questions from the consumer assessment of healthcare providers & systems hospital survey of patient and hospital experience factors. [ 36 ] Further, there are a handful of studies that have generated risk prediction models inclusive of some element of patient response data via self-reported patient questionnaires or even natural language processing.…”

Exploring hospital-based health information technology functions for patients with Alzheimer’s Disease and related Dementias

“…This includes the effective design of patient portals, which can allow patients to view their medical records, schedule appointments, and communicate with their providers through a platform that they can use on their computer or smartphone ( Irizarry et al, 2015 ). Hospitals that report higher rates of adoption of patient engagement functionalities have been found to have lower readmission rates and higher patient satisfaction rates ( Asagbra et al, 2019 , Elysee et al, 2021 ). Patient portals have specifically been found to improve adherence to medications, reduce medical errors, and improve patient-provider communication ( Dendere et al, 2019 ).…”

Toward a More Complete Picture of Readmission-Decreasing Initiatives

“…The fact that recent studies have produced inconsistent results regarding the effects of the quality of hospital care and the use of health IT on readmission rates [9][10][11] raises the question of whether these efforts are misdirected. Regarding the quality of hospital care, a number of researchers have pointed out that much of the difference in readmission risks seems to be explained by patients' demographic, social, and clinical characteristics [11,12], resulting in a low association between readmission rates and other outcome measures (e.g., mortality rates or adherence to recommended hospital care processes) [11,13].…”