Study of the Impact of a Hospital Discharge Care Coordination Program in an Elderly Population

The Effect of an HIE-Supported Care Coordination Package on Hospital Re-Admission Rates in an Elderly Population

The purpose of this research study is to evaluate the effect of a health information exchange (HIE)-supported care coordination package on 30-day readmission rates in a frail elderly population.

Study Overview

• Status: Completed
• Conditions: Hospital Readmission
• Intervention / Treatment: Other: Care Coordination Program

Detailed Description

BACKGROUND

Reducing hospital readmission rates is a top national priority. Unplanned hospital readmission is estimated to have accounted for more than $17 billion of the roughly $103 billion hospital payments made by Medicare in 2004.1 For patients in Medicare fee-for-service programs, the 30-day hospital readmission rates was recently found to be 19.6% nationally, and 20.7% in New York State (Jencks et al., 2009). Hospitals have urgent incentives to address readmission rates: readmission rates have been added to the National Quality Forum performance metrics (National Quality Forum, 2007); readmission rate comparisons are posted on www.hospitalcompare.hss.gov as public indicators of hospital quality; and provisions in health care reform legislation will soon mean that hospitals will not receive payment for many readmissions within 30 days of discharge.

Targeted transitional programs and better coordination of care between inpatient and outpatient settings have the potential to reduce hospital readmission rates (Naylor et al, 2004; Coleman et al, 2006; Peikes et al, 2009). Successful care coordination measures depend upon the effective transmission of health information between the inpatient and outpatient settings.

The Brooklyn Health Information Exchange (BHIX) is a regional health information organization (RHIO) that provides secure health information exchange (HIE) services among participating health-care organizations in Brooklyn, Queens, and other parts of New York City. HIE allows the meaningful sharing of health information of locations where a patients may receive care or healthcare services and can be used to help improve the effective transmission of health information between inpatient and outpatient settings. Maimonides Medical Center is working with BHIX to offer a health information technology- and HIE-based care coordination program (CCP) to help improve the care of frail elderly patients upon discharge. The CCP includes: (1) access to a secure online personal health record (PHR) that people can logon and manage their health information, as well as receive alerts and reminders about action items for them to take on their healthcare; and (2) depending on the patient's health care needs, nursing support (either in-person or by phone).

The main objective of this study to determine the impact of the CCP in a frail elderly population.

SPECIFIC AIMS

Weill Cornell Investigators will be analyzing a HIPAA-defined de-identified dataset from BHIX to evaluate the impact of the CCP. The two main outcomes we will be addressing in our data analysis are:

1. Readmission to any BHIX hospital within 30 days of hospital discharge from Maimonides;
2. Number of inpatient days within 30 days after being discharged from Maimonides Hospital.

See CITATIONS, for references.

• Study Type: Interventional
• Enrollment (Actual): 201
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • New York
    • Brooklyn, New York, United States, 11219
      • Maimonides Medical Center
    • Brooklyn, New York, United States, 11220
      • Brooklyn Health Information Exchange (BHIX)

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 65 years and older (OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Weill Cornell Investigators will be receiving a HIPAA-compliant de-identified dataset from the Brooklyn Health Information Exchange (BHIX) that includes:

  • Demographic data information
  • Diagnoses (admission, discharge, readmission)
  • Whether the patient was readmitted readmission, # of inpatients days if the patients was readmitted
  • Care coordination program statistics (e.g. usage of the personal health record, and frequency of contact with nursing support staff).

• The data set will include data of the following individuals:

  1. Intervention Dataset (Group 1): Those age 65 or older who are discharged from Maimonides to home during the study period and enrolled in the Care Coordination Program.
  2. Control Dataset (Group 2): Those age 65 or older who are discharged from Maimonides to home during the study period.

Exclusion Criteria:

• The exclusion criteria for this study for both the intervention & control dataset is anybody who does not fall into the above inclusion category and anybody who was:

  1. Transferred on the day of discharge to another acute care hospital, admitted to a hospital specialty unit, admitted to an inpatient rehabilitation facility, or admitted to a long-term care hospital;
  2. Approached and declined to participate in the Care Coordination Program.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: HEALTH_SERVICES_RESEARCH
• Allocation: NON_RANDOMIZED
• Interventional Model: PARALLEL
• Masking: NONE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: Intervention Group; Those age 65 or older who are discharged from Maimonides Medical Center to home during the study period and enrolled in the Care Coordination Program	Other: Care Coordination Program; The Care Coordination Program includes: (1) access to a secure online personal health record (PHR) that people can logon and manage their health information, as well as receive alerts and reminders about action items for them to take on their healthcare; and (2) depending on the patient's health care needs, nursing support (either in-person or by phone).; Other Names: Safe at Home Project
NO_INTERVENTION: Control Group; Those age 65 or older who are discharged from Maimonides Medical Center to home

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Hospital Readmission Rates Post 30-day Discharge	To determine the impact of a health information exchange (HIE) care coordination program on reducing hospital readmissions rates post 30-day discharge from Maimonides Medical Center.	1 year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of inpatient hospital days within 30 days of discharge	To determine the impact of a health information exchange (HIE) care coordination program on reducing the number of inpatient days patients experience within 30 days after being discharged from Maimonides Medical Center.	1 year

Collaborators and Investigators

• Sponsor: Weill Medical College of Cornell University
• Collaborators: Maimonides Medical Center; New York State Department of Health
• Investigators: Principal Investigator: Jessica S Ancker, MPH, PhD, Weill Medical College of Cornell University; Study Chair: Melissa C Miller, MPH, Weill Medical College of Cornell University

Publications and helpful links

General Publications

• Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009 Apr 2;360(14):1418-28. doi: 10.1056/NEJMsa0803563. Erratum In: N Engl J Med. 2011 Apr 21;364(16):1582.
• Naylor MD, Brooten DA, Campbell RL, Maislin G, McCauley KM, Schwartz JS. Transitional care of older adults hospitalized with heart failure: a randomized, controlled trial. J Am Geriatr Soc. 2004 May;52(5):675-84. doi: 10.1111/j.1532-5415.2004.52202.x. Erratum In: J Am Geriatr Soc. 2004 Jul;52(7):1228.
• Coleman EA, Parry C, Chalmers S, Min SJ. The care transitions intervention: results of a randomized controlled trial. Arch Intern Med. 2006 Sep 25;166(17):1822-8. doi: 10.1001/archinte.166.17.1822.
• Peikes D, Chen A, Schore J, Brown R. Effects of care coordination on hospitalization, quality of care, and health care expenditures among Medicare beneficiaries: 15 randomized trials. JAMA. 2009 Feb 11;301(6):603-18. doi: 10.1001/jama.2009.126.

Study record dates

Study Major Dates

• Study Start: May 1, 2011
• Primary Completion (ACTUAL): June 1, 2012
• Study Completion (ACTUAL): July 1, 2013

Study Registration Dates

• First Submitted: September 23, 2011
• First Submitted That Met QC Criteria: September 26, 2011
• First Posted (ESTIMATE): September 27, 2011

Study Record Updates

• Last Update Posted (ESTIMATE): January 24, 2017
• Last Update Submitted That Met QC Criteria: January 20, 2017
• Last Verified: January 1, 2017

More Information

Terms related to this study

• Keywords: Health Information Technology; Health Records, Personal; Patient Access to Records; Hospital Information Systems; Medical Records; Medical Record Systems, Computerized
• Other Study ID Numbers: C023699-22

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: A fully deidentified data set listing outcomes for the included patients is available by contacting the study PI (Jessica Ancker, jsa7002@med.cornell.edu)