Showing Health Information Value in a Community Network

The purpose of this study is to determine the value of shared health information on care quality and costs when this information is used to notify care providers about concerning health events for patients cared for by a community-based network of providers.

Study Overview

• Status: Completed
• Conditions: Quality of Healthcare; Population Health Management; Clinical Decision Support; Medical Informatics Interventions
• Intervention / Treatment: Other: Computer-based clinical decision support.

Detailed Description

Project Abstract This three-year project will assess the costs and benefits of health information technology (HIT) in an established community-wide network of academic, private and public healthcare facilities created to share clinical information for the purpose of population-based care management of over 16,000 Medicaid beneficiaries in Durham County, North Carolina. The area of interest for this project is the impact of information-driven interventions on care quality, patient safety and healthcare costs across the diverse stakeholders participating in this collaborative partnership. In order to asses HIT value rigorously in the context of a production information system that is under continual development, we propose to conduct a randomized controlled trial. Specifically, we will randomly assign patients by family unit to either a control group or to an intervention group in which they will initially receive one of 3 information-driven interventions. The interventions include clinical alerts sent to care providers, performance feedback reports presented to clinic managers, and care reminders sent directly to patients. The content of the interventions will address "concerning" events (e.g., an emergency room encounter for asthma) and care deficiencies (e.g., delinquency on biannual mammogram) identified from the composite set of clinical data in our information system. To assess the benefits and burdens of the interventions, combinations of the 3 interventions will be sequentially introduced into the study groups over the course of the project. The analysis will compare groups receiving various combinations of interventions as well as those receiving no interventions. At baseline and at six-month intervals throughout the course of the study, we will measure emergency department encounter rates, hospitalization rates, HEDIS (Healthcare Effectiveness Data and Information Set) scores, missed appointment rates, glycated hemoglobin levels in diabetics, and patient satisfaction. Our assessment will look at the societal value of HIT as well as the value for individual stakeholders including patients, providers, payers, purchasers and policy makers. From these measures, we will assess the costs and benefits of this community-wide effort to promote interoperability of clinical data exchange in order to increase the understanding of HIT value in a community setting. In our preliminary studies, we have observed a statistically significant 3-fold reduction in repeat ED (Emergency Department) encounter rates using email alerts alone. The approach used in this project is able to be generalized across geographic areas and healthcare settings and can, therefore, serve to promote the dissemination of HIT to other communities.

• Study Type: Interventional
• Enrollment (Actual): 20108
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • North Carolina
    • Durham, North Carolina, United States, 27710
      • Duke University Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Enrollment in the Community Care of North Carolina Medicaid program in Durham County North Carolina

Exclusion Criteria:

-

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Factorial Assignment
• Masking: Single

Number of Arms

6

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: 1; electronic mail notifications to care managers about sentinel health events	Other: Computer-based clinical decision support.; computer decision support system that generates notifications about sentinel health events and communicates this information via electronic mail to care managers, feedback reports to clinical managers, and letters to patients; Other Names: Decision support engine is called SEBASTIAN
Experimental: 2; feedback reports with notifications to clinic managers about sentinel health events	Other: Computer-based clinical decision support.; computer decision support system that generates notifications about sentinel health events and communicates this information via electronic mail to care managers, feedback reports to clinical managers, and letters to patients; Other Names: Decision support engine is called SEBASTIAN
Experimental: 3; letters to patients with notifications about sentinel health events	Other: Computer-based clinical decision support.; computer decision support system that generates notifications about sentinel health events and communicates this information via electronic mail to care managers, feedback reports to clinical managers, and letters to patients; Other Names: Decision support engine is called SEBASTIAN
No Intervention: 4; electronic mail notifications to care managers about sentinel health events -- generated but withheld
No Intervention: 5; feedback reports with notifications to clinic managers about sentinel health events -- generated but withheld
No Intervention: 6; letters to patients with notifications about sentinel health events -- generated but withheld

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Emergency department utilization rates and hospitalization rates	at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.

Secondary Outcome Measures

Outcome Measure	Time Frame
ED encounter rates for low severity conditions	at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
ED encounter rates for asthma	at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
ED encounter rates for diabetes	at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
Hospitalization rates	at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
Hospitalization rates for asthma (also PQI)	at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
Hospitalization rates for diabetes (also PQI)	at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
Glycemic control (hemoglobin A1c)	at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
Medication contraindications	at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
HEDIS - Preventive services	at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
HEDIS - # WCC visits	at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
AHRQ Prevention Quality Indicators	at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
HEDIS - Asthma and diabetes	at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
# of messages triggered for health risks	at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
# of messages triggered for barriers to care	at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
Missed appointment rates	at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
Primary care appointment rates	at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
F/U rates post-partum	at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
Patient satisfaction instruments (CHAPS)	at 6 to 9 months after the intervention has been introduced and then at 3 to 6-month intervals as the intervention is sequentially enhanced.
EuroQoL	at 6 to 9 months after the intervention has been introduced and then at 3 to 6-month intervals as the intervention is sequentially enhanced.
Provider opinion surveys	At conclusion of study
Costs of ED utilization for all causes	at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
Costs of ED use for asthma	at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
Costs of ED use for diabetes	at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
Costs of ED use for low severity visits	at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
Hospitalization costs for all causes	at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
Hospitalization costs for asthma	at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
Hospitalization costs for diabetes	at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
Reimbursement for labs+other ancillary services	at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
Primary care reimbursement	at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
ED rates for recurrent ED encounters	at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.

Collaborators and Investigators

• Sponsor: Duke University
• Investigators: Principal Investigator: David F Lobach, MD, PhD, Duke University

Publications and helpful links

General Publications

• Eisenstein EL, Anstrom KJ, Macri JM, Crosslin DR, Johnson FS, Kawamoto K, Lobach DF. Assessing the potential economic value of health information technology interventions in a community-based health network. AMIA Annu Symp Proc. 2005;2005:221-5.

Study record dates

Study Major Dates

• Study Start: August 1, 2006
• Primary Completion (Actual): July 1, 2008
• Study Completion (Actual): August 1, 2008

Study Registration Dates

• First Submitted: August 16, 2006
• First Submitted That Met QC Criteria: August 16, 2006
• First Posted (Estimate): August 18, 2006

Study Record Updates

• Last Update Posted (Estimate): July 11, 2014
• Last Update Submitted That Met QC Criteria: July 9, 2014
• Last Verified: December 1, 2012

More Information

Terms related to this study

• Keywords: Medical Informatics; Community Health Services; Decision Support Systems, Clinical; Costs and Cost analysis
• Other Study ID Numbers: Pro00006833; R01HS015057 (U.S. AHRQ Grant/Contract)