Effects of Health Information Exchanges in the Adult Inpatient Setting: a Systematic Review

Dupont, Sarah; Nemeth, John; Turbow, Sara

doi:10.1007/s11606-022-07872-z

Cited by 5 publications

(5 citation statements)

References 22 publications

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“…There have been a limited number of previous studies examining the relationship between HIE presence and inpatient mortality [ 32 ]: one focused on patients admitted with acute myocardial infarction found no benefit of HIEs [ 15 ], while another focusing on HIE use in interhospital transfers found a 25% lower odds of inpatient mortality [ 33 ]. Our study advances the literature in two key ways: first, by focusing on a patient population that may stand to gain outsized benefit from information exchange, and second, by using a more focused definition of information exchange—namely, whether or not the admitting and readmitting hospital participated in the same HIE—to reduce misclassification bias.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Health Information Exchange on In-Hospital and Postdischarge Mortality in Older Adults with Alzheimer Disease Readmitted to a Different Hospital Within 30 Days of Discharge: Cohort Study of Medicare Beneficiaries

Turbow¹,

Vaughan²,

Culler³

et al. 2023

JMIR Aging

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Background Although electronic health information sharing is expanding nationally, it is unclear whether electronic health information sharing improves patient outcomes, particularly for patients who are at the highest risk of communication challenges, such as older adults with Alzheimer disease. Objective To determine the association between hospital-level health information exchange (HIE) participation and in-hospital or postdischarge mortality among Medicare beneficiaries with Alzheimer disease or 30-day readmissions to a different hospital following an admission for one of several common conditions. Methods This was a cohort study of Medicare beneficiaries with Alzheimer disease who had one or more 30-day readmissions in 2018 following an initial admission for select Hospital Readmission Reduction Program conditions (acute myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease, and pneumonia) or common reasons for hospitalization among older adults with Alzheimer disease (dehydration, syncope, urinary tract infection, or behavioral issues). Using unadjusted and adjusted logistic regression, we examined the association between electronic information sharing and in-hospital mortality during the readmission or mortality in the 30 days following the readmission. Results A total of 28,946 admission-readmission pairs were included. Beneficiaries with same-hospital readmissions were older (aged 81.1, SD 8.6 years) than beneficiaries with readmissions to different hospitals (age range 79.8-80.3 years, P<.001). Compared to admissions and readmissions to the same hospital, beneficiaries who had a readmission to a different hospital that shared an HIE with the admission hospital had 39% lower odds of dying during the readmission (adjusted odds ratio [AOR] 0.61, 95% CI 0.39-0.95). There were no differences in in-hospital mortality observed for admission-readmission pairs to different hospitals that participated in different HIEs (AOR 1.02, 95% CI 0.82-1.28) or to different hospitals where one or both hospitals did not participate in HIE (AOR 1.25, 95% CI 0.93-1.68), and there was no association between information sharing and postdischarge mortality. Conclusions These results indicate that information sharing between unrelated hospitals via a shared HIE may be associated with lower in-hospital, but not postdischarge, mortality for older adults with Alzheimer disease. In-hospital mortality during a readmission to a different hospital was higher if the admission and readmission hospitals participated in different HIEs or if one or both hospitals did not participate in an HIE. Limitations of this analysis include that HIE participation was measured at the hospital level, rather than at the provider level. This study provides some evidence that HIEs can improve care for vulnerable populations receiving acute care from different hospitals.

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Section: Discussionmentioning

confidence: 99%

The Impact of Health Information Exchange on In-Hospital and Postdischarge Mortality in Older Adults with Alzheimer Disease Readmitted to a Different Hospital Within 30 Days of Discharge: Cohort Study of Medicare Beneficiaries

Turbow¹,

Vaughan²,

Culler³

et al. 2023

JMIR Aging

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“…Previous work has shown that HIEs may be associated with reduced costs, 19 less duplication of procedures and imaging, 20 and lower risk of subsequent readmissions [21][22][23] and fragmented readmissions, 22 among other outcomes. 24 The association of information sharing with outcomes may differ across patient populations. If a patient can easily communicate their health history, the effect of outside sources of information on their clinical course may be lessened.…”

Section: Introductionmentioning

confidence: 99%

“…Systems that can bridge the information discontinuity present in fragmented readmissions, namely shared electronic health records (EHRs) and health information exchanges (HIEs), may mitigate some of the negative effects of fragmented readmissions. Previous work has shown that HIEs may be associated with reduced costs, less duplication of procedures and imaging, and lower risk of subsequent readmissions and fragmented readmissions, among other outcomes …”

Section: Introductionmentioning

confidence: 99%

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Association of Fragmented Readmissions and Electronic Information Sharing With Discharge Destination Among Older Adults

et al. 2023

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ImportanceWhen an older adult is hospitalized, where they are discharged is of utmost importance. Fragmented readmissions, defined as readmissions to a different hospital than a patient was previously discharged from, may increase the risk of a nonhome discharge for older adults. However, this risk may be mitigated via electronic information exchange between the admission and readmission hospitals.ObjectiveTo determine the association of fragmented hospital readmissions and electronic information sharing with discharge destination among Medicare beneficiaries.Design, Setting, and ParticipantsThis cohort study retrospectively examined data from Medicare beneficiaries hospitalized for acute myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease, syncope, urinary tract infection, dehydration, or behavioral issues in 2018 and their 30-day readmission for any reason. The data analysis was completed between November 1, 2021, and October 31, 2022.ExposuresSame hospital vs fragmented readmissions and presence of the same health information exchange (HIE) at the admission and readmission hospitals vs no information shared between the admission and readmission hospitals.Main Outcomes and MeasuresThe main outcome was discharge destination following the readmission, including home, home with home health, skilled nursing facility (SNF), hospice, leaving against medical advice, or dying. Outcomes were examined for beneficiaries with and without Alzheimer disease using logistic regressions.ResultsThe cohort included 275 189 admission-readmission pairs, representing 268 768 unique patients (mean [SD] age, 78.9 [9.0] years; 54.1% female and 45.9% male; 12.2% Black, 82.1% White, and 5.7% other race and ethnicity). Of the 31.6% fragmented readmissions in the cohort, 14.3% occurred at hospitals that shared an HIE with the admission hospital. Beneficiaries with same hospital/nonfragmented readmissions tended to be older (mean [SD] age, 78.9 [9.0] vs 77.9 [8.8] for fragmented with same HIE and 78.3 [8.7] years for fragmented without HIE; P &lt; .001). Fragmented readmissions were associated with 10% higher odds of discharge to an SNF (adjusted odds ratio [AOR], 1.10; 95% CI, 1.07-1.12) and 22% lower odds of discharge home with home health (AOR, 0.78; 95% CI, 0.76-0.80) compared with same hospital/nonfragmented readmissions. When the admission and readmission hospital shared an HIE, beneficiaries had 9% to 15% higher odds of discharge home with home health (patients without Alzheimer disease: AOR, 1.09 [95% CI, 1.04-1.16]; patients with Alzheimer disease: AOR, 1.15 [95% CI, 1.01-1.32]) compared with fragmented readmissions where information sharing was not available.Conclusions and RelevanceIn this cohort study of Medicare beneficiaries with 30-day readmissions, whether a readmission is fragmented was associated with discharge destination. Among fragmented readmissions, shared HIE across admission and readmission hospitals was associated with higher odds of discharge home with home health. Efforts to study the utility of HIE for care coordination for older adults should be pursued.

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“…While they suggest that the adoption of universal medical record systems or interhospital health information exchange systems will help ameliorate this issue, I believe this is a hypothesis that needs to be tested rather than accepted at face value. To that end, it is important to note that a recent systematic review 9 found only a handful of observational studies (and with conflicting results) on whether health information exchange impacted readmission rates and another study 10 found that even direct communication between hospital and outpatient physicians did not have any impact on readmission rates. Although Verma et al 6 also suggest a role for more rigorous predischarge counseling and coordination of follow-up visits to mitigate care fragmentation, this is another approach that, while logical, has not yet been proven uniformly beneficial in randomized trials for patients discharged after hospitalizations for conditions other than heart failure.…”

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confidence: 99%

Care Fragmentation After Hospital Discharge

McAlister

2023

JACC: Advances

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Effects of Health Information Exchanges in the Adult Inpatient Setting: a Systematic Review

Cited by 5 publications

References 22 publications

The Impact of Health Information Exchange on In-Hospital and Postdischarge Mortality in Older Adults with Alzheimer Disease Readmitted to a Different Hospital Within 30 Days of Discharge: Cohort Study of Medicare Beneficiaries

The Impact of Health Information Exchange on In-Hospital and Postdischarge Mortality in Older Adults with Alzheimer Disease Readmitted to a Different Hospital Within 30 Days of Discharge: Cohort Study of Medicare Beneficiaries

Association of Fragmented Readmissions and Electronic Information Sharing With Discharge Destination Among Older Adults

Care Fragmentation After Hospital Discharge

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