Long-Term and Post-Acute Care Providers Engaged in Health Information Exchange: Final Report. B.5. Facet: Outcomes of Health Information Exchange to Support Care Coordination

10/29/2013

The outcomes facet provides the categories of the measures related to HIE approaches and affect care coordination, quality, satisfaction (e.g., with care coordination, care, HIE), efficiency and costs.12345678910

TABLE B-6. Examples of Categories Associated with the Outcomes Facet

  Category     Characteristics     Examples of Sub-categories  
and Measures
  Important to Capture  
for LTPAC/LTSS HIE
Clinical
  • Clinical outcomes related to HIE.
  • Quality measures.
  • Perceived impact on care.
  • Goals & outcomes to optimize function, prevent deterioration, manage acute exacerbations, & support self-management.
  • Metrics used to assess the impact of the intervention on the quality & safety of transitions in care:
    • Clinical impact & process measures, HIE for care planning, medication review, care monitoring, prevention of adverse outcomes such as pressure ulcers, delirium, falls, cognitive decline.
    • Hospital admission & readmission rates.
    • Medication errors & ADEs.
    • Patient/resident outcomes: morbidity functionality, mortality, cognitive performance.
  • Measures sensitive to HIE such as hospitalization rates, medication errors, compliance with care guidelines, chronic care management.1
  • Patient perspectives of their experience, in defining whether or not their care is successfully coordinated.
Business/Financial
  • Cost savings or expenditures are part of the business outcomes.
  • Includes reductions in utilization (e.g., hospital days, associated patient bed days of care for readmissions, medication errors, laboratory tests, medications), efficiencies, & associated costs.
  • ED, inpatient, other care costs & cost savings attributable to HIE use.2,3,4
Adoption
  • Includes the number of users of HIE, how used, & depth of their use.
  • Captured as a percentage of users to potential users; level of use of a HIE system or HIE intervention can be quantified a variety of way such as usage, over time, relative to opportunities, & by type of usage (ED setting, discharge to new care setting, admission, by care planning team, pharmacy).
  • Number of users by clinical discipline using an HIE approach, intervention or tool.
Care Coordination Measures
  • Measures that reflect how well care is coordinated.
  • Care transitions measures, continuity of care, collaboration & satisfaction about care. (See Care Coordination Measures Atlas).5,6
  • Pioneer ACO measures.

NOTES:

  1. Kern LM Dhopeshwarkar R, Barron Y, et al. Measuring the effects of health information technology on quality of care: A novel set of proposed metrics for electronic quality report. Jt Com J Qual Patient Saf; 2009; 35(7): 359-369.
  2. Frisse ME, Johnson KB, Nian H, et al. The financial impact of health information exchange on emergency department care. J Am Med Inform Assoc; 2012; 19(3): 328-333.
  3. Kern LM, Wilcox A, Shapiro J, et al. Which components of health information technology will drive financial value? Am J Manag Care; 2012; 18(8): 438-445.
  4. Bailey JE, Wan JY, Mabry LM, et al. Does health information exchange reduce unnecessary neuroimaging and improve quality of headache care in the emergency department? J Gen Intern Med; 2013; 28(2): 176-183.
  5. McDonald K, Schultz E, Albin L, et al. Care coordination measures atlas version 3. Rockville, MD: Prepared by Stanford University under Subcontract to Battelle on Contract No. 290-04-0020 for the AHRQ; 2010. AHRQ Publication No. 11-0023-EF.
  6. Leath B, Mardon R, Atkinson D, et al. NIH-community care coordination performance measures (NIH-CCCPM) project technical report on project: Standardizing community care coordination measures linked to improvements in quality of life and health outcomes among vulnerable populations. Rockville, MD: Westat; 2012.

  1. Forster AJ, Murff HJ, Peterson JF, et al. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med; 2003; 138(3): 161-167.

  2. Frisse ME, Johnson KB, Nian H, et al. The financial impact of health information exchange on emergency department care. J Am Med Inform Assoc; 2012; 19(3): 328-333.

  3. Society of Hospital Medicine. Project BOOST: Better outcomes for older adults through safe transitions. Available athttp://www.hospitalmedicine.org/AM/Template.cfm?Section=Home&CONTENTID=27659&TEMPLATE=/CM/HTMLDisplay.cfm. Accessed August 6, 2012.

  4. Kern LM, Wilcox A, Shapiro J, et al. Which components of health information technology will drive financial value? Am J Manag Care; 2012; 18(8): 438-445.

  5. Gordon P, Camhi E, Hesse R, et al. Processes and outcomes of developing a continuity of care document for use as a personal health record by people living with HIV/AIDS in New York City. Int J Med Inf; 2012; 81(10): e63-e73.

  6. Leath B, Mardon R, Atkinson D, et al. NIH-community care coordination performance measures (NIH-CCCPM) project technical report on project: Standardizing community care coordination measures linked to improvements in quality of life and health outcomes among vulnerable populations. Rockville, MD: Westat; 2012.

  7. Wolf L. National Governor's Association long-term care and health information exchange coordinate care to improve outcomes. Kindred Healthcare; 2011. Available at http://www.nga.org/files/live/sites/NGA/files/pdf/1105HIELARRY.PDF.

  8. Bailey JE, Wan JY, Mabry LM, et al. Does health information exchange reduce unnecessary neuroimaging and improve quality of headache care in the emergency department? J Gen Intern Med; 2013; 28(2): 176-183.

  9. Kern LM, Dhopeshwarkar R, Barron Y, et al. Measuring the effects of health information technology on quality of care: A novel set of proposed metrics for electronic quality reporting. Jt Comm J Qual Patient Saf; 2009; 35(7): 359-369.

  10. Kern LM, Blumenthal D, Pincus H, et al. Quality measures for capturing the effects of health information exchange. AMIA Annu Symp Proc; 2008; 1001.

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