(Focus on Diabetes, Asthma, Hypertension, CHF, COPD, CAD, Clinical Trial
Official title:
Evaluation of a Regional Electronic Health Information Exchange's Clinical Health Record
The Shared Health CHR™ (Clinical Health Record) offers point-of-care clinical reporting and decision support based primarily on patient claims data aggregated across various health care settings, and is one example of the types of health information data exchange efforts being implemented across the country. This study will evaluate how the CHR is used and its clinical and financial impact to better understand the CHR's value, and to identify opportunities to enhance the system to support patient care and practice efficiency. In addition, the results from this study will help to inform the national debate about the effectiveness of these types of tools to maximize patient quality of care, patient safety, and practice efficiency.
Missing information at the point of care is frustrating for both physicians and patients and
can lead to unnecessary tests or suboptimal or even inappropriate and potentially harmful
treatment. In addition to the risks of poorer quality of care, this fragmentation of
incomplete or unavailable clinical data may result in increased costs to the healthcare
system. Patient health records, when electronically shared across a spectrum of patient care
settings, offer the possibility of improving healthcare outcomes, including patient safety
and quality of care, and increasing efficiency, as well as cost-effectiveness.
This overall study will consist of two analyses. First, we will conduct a before-and-after,
or pre-post study. The clinical practices consenting to participate will serve as their own
controls during the baseline period. During the baseline period for which data will be
retrospectively captured, physicians will have been conducting "business as usual" without
the use of the CHR. The intervention will consist of participants accessing CHR to assist
with medical decisions and patient care. Secondly, we will conduct a concurrent matched
cohort comparison of patients within practices. We will compare outcomes and gaps in care for
patients whose care is associated with very frequent CHR use and less frequent CHR use to
matched control patients whose care is not associated with CHR use.
Safety, quality, and cost outcomes will be compared using the two described approaches.
First, we will compare outcomes and gaps in care for the intervention patients whose care
involved active CHR use in the intervention period to the care these same patients received
during the baseline periods (pre/post analyses). Secondly, we will compare outcomes and gaps
in care of the intervention active patients, both super-active and less active, to the
matched control patients whose care during the study did not involve any CHR use during the
intervention period (matched cohort analysis).
In order to study the relationship of CHR use to clinical, financial, and office efficiency
outcomes within the study's timeline, we will limit our study to pre-existing patients and
new patients who have had at least one encounter during the study period. Hospital admission
data will also be analyzed as part of the cost and outcomes analysis.
We plan to study the effects of CHR on several conditions among the AHRQ's Ambulatory Care
Sensitive (ACS) Conditions. We will study conditions that are common, high-risk, and resource
dependent where clinical management may be improved with access to a CHR including chronic
obstructive pulmonary disease/asthma, congestive heart failure, angina/coronary artery
disease, and diabetes mellitus. In addition, other conditions determined to be of value in
evaluating the impact of the CHR may be added, or may replace some of the existing
conditions. These conditions will be chosen based on our early work in the study once we
learn more about the number of eligible patients and the numbers of clinical interactions.
The new conditions, yet to be determined, may also include non-chronic, or acute, diagnoses.
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