Health information exchange (HIE) participation in Florida was associated with readmission reduction, meaning hospitals should be encouraged to integrate HIE into their quality improvement initiatives, according to new research published in Health Affairs.
Researchers from Florida International University analyzed state-level data for 2011 to 2014 from 160 Florida hospitals to examine the relationship between hospitals’ participation in health information exchange and quality and health outcomes. They found that HIE participation was associated with a decrease in the probability of unplanned, 30-day readmissions for acute myocardial infarction (AMI, heart attack) that was 1.3 percentage points greater than that seen at non-participating hospitals.
This decrease was driven primarily by reduced readmissions to hospitals other than those that provided initial inpatient treatment. “These findings indicate that HIE can be leveraged to improve quality measures targeted by the Hospital Readmissions Reduction Program and may hold promise for achieving broader policy goals,” researchers concluded.
As the study’s authors noted, respite the recent growth of HIE and its potential benefits, evidence of its impact on patient outcomes is very limited. Most studies have focused on resource use in ambulatory care and emergency department (ED) settings, and found that HIE reduces ED costs as well as duplicative laboratory and radiology testing. However, only a few studies have examined the impact on quality of care in inpatient settings, and their findings are mixed, they commented.
Due to meaningful use requirements during the time period for this study, the proportion of hospitals participating in electronic exchange of health information with outside providers increased substantially, the researchers pointed out, noting that in 2014, nearly 50 percent of hospitals actively exchanged electronic health information with ambulatory care providers or hospitals outside their organization—a nearly four-fold increase relative to 2011
The sample consisted of more than 80,000 AMI admissions in Florida; 63-percent of these admissions occurred in hospitals that began to participate in HIE in 2011 to 2014 (treatment group). The 30-, 45-, and 60-day all-cause readmission rates of AMI patients in the treatment group were 20 percent, 22 percent, and 24 percent, respectively—all significantly lower than the rates of patients in the control group, the data revealed.
According to the study’s authors, difference-in-differences in predicted changes in 30-day readmission rates showed that on average, “hospitals that became HIE participants performed significantly better than hospitals that remained nonparticipants, with a decline in 30-day all-cause readmissions that was 1.3 percentage points greater for participating hospitals. This readmission reduction was primarily driven by a decline in readmissions to a hospital other than the index hospital, which implies an improvement in continuity of care at the index hospital.”
“Achieving widespread exchange of health information is believed to boost treatment efficiency, reduce healthcare costs and improve patient outcomes,” said Min Chen, associate professor in the Department of Information Systems and Business Analytics at FIU Business. “The findings show that HIE can be leveraged to improve quality measures targeted by the Hospital Readmissions Reduction Program.”
