Leveraging a health information exchange to examine the accuracy of self-report emergency department utilization data among hospitalized injury survivors

Lauren K Whiteside, Marie C Vrablik, Joan Russo, Eileen M Bulger, Deepika Nehra, Kathleen Moloney, Douglas F Zatzick, Lauren K Whiteside, Marie C Vrablik, Joan Russo, Eileen M Bulger, Deepika Nehra, Kathleen Moloney, Douglas F Zatzick

Abstract

Background: Accurate acute care medical utilization history is an important outcome for clinicians and investigators concerned with improving trauma center care. The objective of this study was to examine the accuracy of self-report emergency department (ED) utilization compared with utilization obtained from the Emergency Department Information Exchange (EDIE) in admitted trauma surgery patients with comorbid mental health and substance use problems.

Methods: This is a retrospective cohort study of 169 injured patients admitted to the University of Washington's Harborview Level I Trauma Center. Patients had high levels of post-traumatic stress disorder and depressive symptoms, suicidal ideation and alcohol comorbidity. The investigation used EDIE, a novel health technology tool that collects information at the time a patient checks into any ED in Washington and other US states. Patterns of EDIE-documented visits were described, and the accuracy of injured patients' self-report visits was compared with EDIE-recorded visits during the course of the 12 months prior to the index trauma center admission.

Results: Overall, 45% of the sample (n=76) inaccurately recalled their ED visits during the past year, with 36 participants (21%) reporting less ED visits than EDIE indicated and 40 (24%) reporting more ED visits than EDIE indicated. Patients with histories of alcohol use problems and major psychiatric illness were more likely to either under-report or over-report ED health service use.

Discussion: Nearly half of all patients were unable to accurately recall ED visits in the previous 12 months compared with EDIE, with almost one-quarter of patients demonstrating high levels of disagreement. The improved accuracy and ease of use when compared with self-report make EDIE an important tool for both clinical and pragmatic trial longitudinal outcome assessments. Orchestrated investigative and policy efforts could further examine the benefits of introducing EDIE and other information exchanges into routine acute care clinical workflows.

Level of evidence: II/III.

Trial registration number: ClinicalTrials.gov NCT02274688.

Keywords: patient reported outcome measures; post-traumatic; stress disorders; substance-related disorders; wounds and injuries.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Bland-Altman plot of differences between participants’ self-report and EDIE-documented number of emergency department (ED) visits versus the mean number of ED visits. EDIE, Emergency Department Information Exchange.

References

    1. Sakran JV, Ezzeddine H, Schwab CW, Bonne S, Brasel KJ, Burd RS, Cuschieri J, Ficke J, Gaines BA, Giacino JT, et al. . Proceedings from the consensus conference on trauma patient-reported outcome measures. J Am Coll Surg 2020;230:819–35. 10.1016/j.jamcollsurg.2020.01.032
    1. Godat LN, Jensen AR, Stein DM, Coalition for National Trauma Research Scientific Advisory Council . Patient-centered outcomes research and the injured patient: a summary of application. Trauma Surg Acute Care Open 2020;5:e000422. 10.1136/tsaco-2019-000422
    1. Rosenberg GM, Stave C, Spain DA, Weiser TG. Patient-reported outcomes in trauma: a scoping study of published research. Trauma Surg Acute Care Open 2018;3:e000202. 10.1136/tsaco-2018-000202
    1. Haider AH, Herrera-Escobar JP, Al Rafai SS, Harlow AF, Apoj M, Nehra D, Kasotakis G, Brasel K, Kaafarani HMA, Velmahos G, et al. . Factors associated with long-term outcomes after injury: results of the functional outcomes and recovery after trauma emergencies (FORTE) multicenter cohort study. Ann Surg 2020;271:1165–73. 10.1097/SLA.0000000000003101
    1. MacKenzie EJ, Rivara FP, Jurkovich GJ, Nathens AB, Frey KP, Egleston BL, Salkever DS, Scharfstein DO. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med 2006;354:366–78. 10.1056/NEJMsa052049
    1. Zatzick D, Jurkovich G, Rivara FP, Russo J, Wagner A, Wang J, Dunn C, Lord SP, Petrie M, Oʼconnor SS, et al. . A randomized stepped care intervention trial targeting posttraumatic stress disorder for surgically hospitalized injury survivors. Ann Surg 2013;257:390–9. 10.1097/SLA.0b013e31826bc313
    1. Melnick ER, Jeffery MM, Dziura JD, Mao JA, Hess EP, Platts-Mills TF, Solad Y, Paek H, Martel S, Patel MD, et al. . User-centred clinical decision support to implement emergency department-initiated buprenorphine for opioid use disorder: protocol for the pragmatic group randomised embed trial. BMJ Open 2019;9:e028488. 10.1136/bmjopen-2018-028488
    1. Grudzen CR, Brody AA, Chung FR, Cuthel AM, Mann D, McQuilkin JA, Rubin AL, Swartz J, Tan A, Goldfeld KS, et al. . Primary palliative care for emergency medicine (PRIM-ER): protocol for a pragmatic, cluster-randomised, stepped wedge design to test the effectiveness of primary palliative care education, training and technical support for emergency medicine. BMJ Open 2019;9:e030099. 10.1136/bmjopen-2019-030099
    1. Zatzick DF, Russo J, Darnell D, Chambers DA, Palinkas L, Van Eaton E, Wang J, Ingraham LM, Guiney R, Heagerty P, et al. . An effectiveness-implementation hybrid trial study protocol targeting posttraumatic stress disorder and comorbidity. Implement Sci 2016;11:58. 10.1186/s13012-016-0424-4
    1. Loudon K, Treweek S, Sullivan F, Donnan P, Thorpe KE, Zwarenstein M. The PRECIS-2 tool: designing trials that are fit for purpose. BMJ 2015;350:h2147. 10.1136/bmj.h2147
    1. Califf RM, Sugarman J. Exploring the ethical and regulatory issues in pragmatic clinical trials. Clin Trials 2015;12:436–41. 10.1177/1740774515598334
    1. Van Eaton EG, Zatzick DF, Gallagher TH, Tarczy-Hornoch P, Rivara FP, Flum DR, Peterson R, Maier RV. A nationwide survey of trauma center information technology leverage capacity for mental health comorbidity screening. J Am Coll Surg 2014;219:505–10. 10.1016/j.jamcollsurg.2014.02.032
    1. Martin TJ, Ranney ML, Dorroh J, Asselin N, Sarkar IN. Health information exchange in emergency medical services. Appl Clin Inform 2018;9:884–91. 10.1055/s-0038-1676041
    1. Shapiro JS, Crowley D, Hoxhaj S, Langabeer J, Panik B, Taylor TB, Weltge A, Nielson JA. Health information exchange in emergency medicine. Ann Emerg Med 2016;67:216–26. 10.1016/j.annemergmed.2015.06.018
    1. Kimmel HJ, Brice YN, Trikalinos TA, Sarkar IN, Ranney ML. Real-Time emergency department electronic notifications regarding high-risk patients: a systematic review. Telemed J E Health 2019;25:604–18. 10.1089/tmj.2018.0117
    1. Khurshid A, Diana ML, Jain R. Health information exchange readiness for demonstrating return on investment and quality of care. Perspect Health Inf Manag 2015;12:1d.
    1. Gryczynski J, Nordeck CD, Martin RD, Welsh C, Schwartz RP, Mitchell SG, Jaffe JH. Leveraging health information exchange for clinical research: extreme underreporting of hospital service utilization among patients with substance use disorders. Drug Alcohol Depend 2020;212:107992. 10.1016/j.drugalcdep.2020.107992
    1. Bhandari A, Wagner T. Self-reported utilization of health care services: improving measurement and accuracy. Med Care Res Rev 2006;63:217–35. 10.1177/1077558705285298
    1. Cleary PD, Jette AM. The validity of self-reported physician utilization measures. Med Care 1984;22:796–803. 10.1097/00005650-198409000-00003
    1. Glass JE, Bucholz KK. Concordance between self-reports and archival records of physician visits: a case-control study comparing individuals with and without alcohol use disorders in the community. Drug Alcohol Depend 2011;116:57–63. 10.1016/j.drugalcdep.2010.11.021
    1. Baillargeon J, Thomas CR, Williams B, Begley CE, Sharma S, Pollock BH, Murray OJ, Pulvino JS, Raimer B. Medical emergency department utilization patterns among uninsured patients with psychiatric disorders. Psychiatr Serv 2008;59:808–11. 10.1176/ps.2008.59.7.808
    1. Shapiro JS, Johnson SA, Angiollilo J, Fleischman W, Onyile A, Kuperman G. Health information exchange improves identification of frequent emergency department users. Health Aff 2013;32:2193–8. 10.1377/hlthaff.2013.0167
    1. Selby JV, Fireman BH, Swain BE. Effect of a copayment on use of the emergency department in a health maintenance organization. N Engl J Med Overseas Ed 1996;334:635–42. 10.1056/NEJM199603073341006
    1. Finnell JT, Overhage JM, Dexter PR, Perkins SM, Lane KA, McDonald CJ, 2003. Community clinical data exchange for emergency medicine patients. AMIA Annual Symposium proceedings AMIA Symposium 235–8.
    1. Grinspan ZM, Abramson EL, Banerjee S, Kern LM, Kaushal R, Shapiro JS, 2013. Potential value of health information exchange for people with epilepsy: crossover patterns and missing clinical data. AMIA Annual Symposium proceedings AMIA Symposium 527–36.
    1. Collective Medical Technologies The Emergency Department Information Exchange. (11 Apr 2016).
    1. Collective Medical Hospitals using Collective Medical for notifications will fully meet the requirements of the new conditions for participation. 2020. (20 Aug 2020).
    1. Collective Network Information: Collective Medical. 2020.
    1. Zatzick D, Russo J, Thomas P, Darnell D, Teter H, Ingraham L, Whiteside LK, Wang J, Guiney R, Parker L, et al. . Patient-Centered care transitions after injury hospitalization: a comparative effectiveness trial. Psychiatry 2018;81:141–57. 10.1080/00332747.2017.1354621
    1. Russo J, Katon W, Zatzick D. The development of a population-based automated screening procedure for PTSD in acutely injured hospitalized trauma survivors. Gen Hosp Psychiatry 2013;35:485–91. 10.1016/j.genhosppsych.2013.04.016
    1. Zatzick DF, Kang SM, Hinton WL, Kelly RH, Hilty DM, Franz CE, Le L, Kravitz RL. Posttraumatic concerns: a patient-centered approach to outcome assessment after traumatic physical injury. Med Care 2001;39:327–39. 10.1097/00005650-200104000-00004
    1. Blanchard EB, Jones-Alexander J, Buckley TC, Forneris CA. Psychometric properties of the PTSD checklist (PCL). Behav Res Ther 1996;34:669–73. 10.1016/0005-7967(96)00033-2
    1. Zatzick D, Donovan D, Dunn C, Russo J, Wang J, Jurkovich G, Rivara F, Whiteside L, Ries R, Gentilello L. Substance use and posttraumatic stress disorder symptoms in trauma center patients receiving mandated alcohol screening and brief intervention. J Subst Abuse Treat 2012;43:410–7. 10.1016/j.jsat.2012.08.009
    1. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001;16:606–13. 10.1046/j.1525-1497.2001.016009606.x
    1. Zatzick D, Russo J, Lord SP, Varley C, Wang J, Berliner L, Jurkovich G, Whiteside LK, O'Connor S, Rivara FP. Collaborative care intervention targeting violence risk behaviors, substance use, and posttraumatic stress and depressive symptoms in injured adolescents: a randomized clinical trial. JAMA Pediatr 2014;168:532–9. 10.1001/jamapediatrics.2013.4784
    1. Bradley KA, DeBenedetti AF, Volk RJ, Williams EC, Frank D, Kivlahan DR. AUDIT-C as a brief screen for alcohol misuse in primary care. Alcohol Clin Exp Res 2007;31:1208–17. 10.1111/j.1530-0277.2007.00403.x
    1. Bland JM, Altman DG. Measuring agreement in method comparison studies. Stat Methods Med Res 1999;8:135–60. 10.1177/096228029900800204
    1. Giavarina D. Understanding Bland Altman analysis. Biochem Med 2015;25:141–51. 10.11613/BM.2015.015
    1. Bulger EM, Kuhls DA, Campbell BT, Bonne S, Cunningham RM, Betz M, Dicker R, Ranney ML, Barsotti C, Hargarten S, et al. . Proceedings from the medical Summit on firearm injury prevention: a public health approach to reduce death and disability in the US. J Am Coll Surg 2019;229:415–30. e412. 10.1016/j.jamcollsurg.2019.05.018
    1. Gabbe BJ, Simpson PM, Harrison JE, Lyons RA, Ameratunga S, Ponsford J, Fitzgerald M, Judson R, Collie A, Cameron PA. Return to work and functional outcomes after major trauma: who recovers, when, and how well? Ann Surg 2016;263:623–32. 10.1097/SLA.0000000000001564
    1. Sims DW, Bivins BA, Obeid FN, Horst HM, Sorensen VJ, Fath JJ. Urban trauma: a chronic recurrent disease. J Trauma 1989;29:940–7.
    1. Whiteside LK, Darnell D, Jackson K, Wang J, Russo J, Donovan DM, Zatzick DF. Collaborative care from the emergency department for injured patients with prescription drug misuse: an open feasibility study. J Subst Abuse Treat 2017;82:12–21. 10.1016/j.jsat.2017.08.005
    1. Rahurkar S, Vest JR, Menachemi N. Despite the spread of health information exchange, there is little evidence of its impact on cost, use, and quality of care. Health Aff 2015;34:477–83. 10.1377/hlthaff.2014.0729
    1. Rockett IRH, Putnam SL, Jia H, Chang CF, Smith GS. Unmet substance abuse treatment need, health services utilization, and cost: a population-based emergency department study. Ann Emerg Med 2005;45:118–27. 10.1016/j.annemergmed.2004.08.003
    1. Finnell JT, Overhage JM, Grannis S, 2011. All health care is not local: an evaluation of the distribution of emergency department care delivered in Indiana. AMIA Annual Symposium proceedings AMIA Symposium 409–16.
    1. Horrocks D, Kinzer D, Afzal S, Alpern J, Sharfstein JM. The adequacy of individual hospital data to identify high Utilizers and assess community health. JAMA Intern Med 2016;176:856–8. 10.1001/jamainternmed.2016.1248
    1. Massoudi BL, Marcial LH, Tant E, Adler-Milstein J, West SL. Using health information exchanges to calculate clinical quality measures: a study of barriers and facilitators. Healthc 2016;4:104–8. 10.1016/j.hjdsi.2016.04.003
    1. American College of Surgeons Committee on Trauma Resources for optimal care of the injured patient: 2014. 6th edn Chicago, IL: American College of Surgeons, 2014.
    1. Poon SJ, Greenwood-Ericksen MB, Gish RE, Neri PM, Takhar SS, Weiner SG, Schuur JD, Landman AB. Usability of the Massachusetts prescription drug monitoring program in the emergency department: a mixed-methods study. Acad Emerg Med 2016;23:406–14. 10.1111/acem.12905
    1. Zech J, Husk G, Moore T, Shapiro J. Measuring the degree of unmatched patient records in a health information exchange using exact matching. Appl Clin Inform 2016;07:330–40. 10.4338/ACI-2015-11-RA-0158

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir