Showing Health Information Value in a Community Network

Clinical Decision Support Clinical Trial

Official title:

Showing Health Information Value in a Community Network

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00365885
• Other study ID #: Pro00006833
• Secondary ID: R01HS015057
• Status: Completed
• Phase: N/A
• First received: August 16, 2006
• Last updated: July 9, 2014
• Start date: August 2006
• Est. completion date: August 2008

Study information

• Verified date: December 2012
• Source: Duke University
• Contact: n/a
• Is FDA regulated: No
• Health authority: United States: Institutional Review Board
• Study type: Interventional

Clinical Trial Summary

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.

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.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 20108
• Est. completion date: August 2008
• Est. primary completion date: July 2008
• Accepts healthy volunteers: No
• Gender: Both
• Age group: N/A and older

Eligibility

Inclusion Criteria:

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

Exclusion Criteria:

Study Design

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Factorial Assignment, Masking: Single Blind (Subject), Primary Purpose: Treatment

Related Conditions & MeSH terms

• Clinical Decision Support
• Medical Informatics Interventions
• Population Health Management
• Quality of Healthcare

Intervention

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

Locations

Country	Name	City	State
United States	Duke University Medical Center	Durham	North Carolina

Sponsors (1)

Lead Sponsor	Collaborator
Duke University

Country where clinical trial is conducted

United States, 

References & Publications (1)

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. 2005:221-5. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	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.	No
Secondary	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.	No
Secondary	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.	No
Secondary	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.	No
Secondary	Hospitalization rates		at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.	No
Secondary	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.	No
Secondary	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.	No
Secondary	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.	No
Secondary	Medication contraindications		at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.	No
Secondary	HEDIS - Preventive services		at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.	No
Secondary	HEDIS - # WCC visits		at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.	No
Secondary	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.	No
Secondary	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.	No
Secondary	# 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.	No
Secondary	# 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.	No
Secondary	Missed appointment rates		at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.	No
Secondary	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.	No
Secondary	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.	No
Secondary	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.	No
Secondary	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.	No
Secondary	Provider opinion surveys		At conclusion of study	No
Secondary	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.	No
Secondary	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.	No
Secondary	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.	No
Secondary	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.	No
Secondary	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.	No
Secondary	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.	No
Secondary	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.	No
Secondary	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.	No
Secondary	Primary care reimbursement		at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.	No
Secondary	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.	No