Showing Health Information Value in a Community Network
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Purpose
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.
| Condition | Intervention |
|---|---|
|
Clinical Decision Support Medical Informatics Interventions Population Health Management Quality of Healthcare |
Other: Computer-based clinical decision support. |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Factorial Assignment Masking: Single Blind (Subject) Primary Purpose: Treatment |
| Official Title: | Showing Health Information Value in a Community Network |
- Emergency department utilization rates and hospitalization rates [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
- ED encounter rates for low severity conditions [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
- ED encounter rates for asthma [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
- ED encounter rates for diabetes [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
- Hospitalization rates [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
- Hospitalization rates for asthma (also PQI) [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
- Hospitalization rates for diabetes (also PQI) [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
- Glycemic control (hemoglobin A1c) [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
- Medication contraindications [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
- HEDIS - Preventive services [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
- HEDIS - # WCC visits [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
- AHRQ Prevention Quality Indicators [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
- HEDIS - Asthma and diabetes [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
- # of messages triggered for health risks [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
- # of messages triggered for barriers to care [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
- Missed appointment rates [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
- Primary care appointment rates [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
- F/U rates post-partum [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
- Patient satisfaction instruments (CHAPS) [ Time Frame: 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. ] [ Designated as safety issue: No ]
- EuroQoL [ Time Frame: 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. ] [ Designated as safety issue: No ]
- Provider opinion surveys [ Time Frame: At conclusion of study ] [ Designated as safety issue: No ]
- Costs of ED utilization for all causes [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
- Costs of ED use for asthma [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
- Costs of ED use for diabetes [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
- Costs of ED use for low severity visits [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
- Hospitalization costs for all causes [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
- Hospitalization costs for asthma [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
- Hospitalization costs for diabetes [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
- Reimbursement for labs+other ancillary services [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
- Primary care reimbursement [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
- ED rates for recurrent ED encounters [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
| Enrollment: | 20108 |
| Study Start Date: | August 2006 |
| Study Completion Date: | August 2008 |
| Primary Completion Date: | July 2008 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
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 Name: 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 Name: 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 Name: 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
|
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.
Eligibility| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Enrollment in the Community Care of North Carolina Medicaid program in Durham County North Carolina
Exclusion Criteria:
-
Contacts and Locations| United States, North Carolina | |
| Duke University Medical Center | |
| Durham, North Carolina, United States, 27710 | |
| Principal Investigator: | David F Lobach, MD, PhD | Duke University |
More Information
Publications:
| Responsible Party: | Duke University |
| ClinicalTrials.gov Identifier: | NCT00365885 History of Changes |
| Other Study ID Numbers: | Pro00006833 (R01-HS015057), R01-HS015057 |
| Study First Received: | August 16, 2006 |
| Last Updated: | December 10, 2012 |
| Health Authority: | United States: Institutional Review Board |
Keywords provided by Duke University:
|
Medical Informatics Decision Support Systems, Clinical Community Health Services Costs and Cost analysis |
ClinicalTrials.gov processed this record on May 23, 2013