Reducing Hospital Readmissions: a HITEC Study on Community-Based HIE

Reducing Hospital ReadmissionsBy Sarianne Gruber
Twitter: @subtleimpact

The New York Health Information Technology Evaluation Collaborative (HITEC) selected to study the association between the usage of an HIE system post-discharge and 30-day same cause hospital readmissions among patients in Rochester, NY. “The Potential for Community-Based Health Information Exchange Systems to Reduce Hospital Readmissions”, by investigators Joshua R. Vest, Lisa M. Kern, Michael D. Silver and Rainu Kaushai, was published last summer in the Journal of the American Medical Informatics Association.  The retrospective cohort study was conducted during a 6-month period starting from 2009 into 2010. HIE usage was defined as any access of a patient’s information through the web-based portal after discharge from the index hospital and before the date of readmission. The scope of the HIE in the Rochester community included 11 counties, 38 healthcare organizations, over 1300 HIE users, and more than 800,000 patients.

About the HIE System
As one of the nine Qualified Entities of the Statewide Health Information Network of New York, the Rochester Regional Health Information Organization (RHIO) is a non-profit, community-run, data management organization that facilitates a secure electronic health information exchange access for authorized medical providers. The Rochester RHIO information is exchanged via a web-based portal, which includes discharge summaries, diagnoses, radiology results, lab reports and images, medication history, and payer information. The RHIO was developed by and for doctors, hospital systems, health insurers and privacy officers in the Greater Rochester area, and serves a 13-county region in New York’s Finger Lake region. The HIE was first operational in 2009 and has been certified by EHNAC and Direct Trust. More than two-thirds of the region’s 24 hospitals and physicians currently participate, and patients are given the option to “opt-in”.

The Triple Aim Impact
Hospitals readmissions are a pain point and a financial burden given the exposure to penalties imposed by the Hospital Readmission Reduction Program. Reports state the readmission rates range from 18% to 25% of discharges, and the estimated cost is about $17 billion each year. Studies have documented a lack information exchange between providers after patient discharge contributes to readmissions. With the Rochester HIE as an information source on recent hospitalizations as well as transitions of care post-discharge, effective research could document the impact of exchanged information among, providers, hospitals, care facilities and payers, and its effect on readmissions.

The Variable Analysis
The sample included 6807 patients with an overall same-cause readmission rate of 9.8%. To ensure a sufficient sample size for hospital level data, just 11 hospitals met selection criteria for analysis. Claims data, from two health plans that insure more than 60% of the area population, contained patient demographics, diagnoses and encounter information. The cohort included only the patient’s first hospital admission within the first 5 months after consent. The dependent variable was the readmission status within 30 days of discharge for the same cause as the index hospital. Additional independent variables were patient sex, age, insurance type, patient disease severity as the count of Major Aggregated Diagnostic Groups (ADGs). Whether or not a patient had any primary care, specialty care or ED visits in the 30 days post index hospitalization were also modeled.

The HIE Study Post-Discharge Results

  • Of the patients whose data were accessed in the HIE, 5.1% were readmitted to the hospital; whereas of the patients whose data were not accessed 10.1% were readmitted within 30 days for the same condition (p=.001)
  • If the HIE system was accessed, the unadjusted odds ratio of a readmission was 54% lower in the 30 post discharge compared to if it was not accessed (or .46)
  • Controlling for patient characteristics, HIE accessed 55% lower odds of readmission
  • Adding post-discharge utilization, HIE access was associate with 57% lower odds of admission
  • In the full model controlling for patient characteristics, patient post discharge utilization and hospital characteristics, HIE system access was significantly associated with s 57% lower odds ratio of readmission.
  • The estimated financial savings associated with HIE system usage totaled $605,472 annually, accounted for an estimated 48 potentially avoided readmissions each year.

A Community-Based HIE Shows Success

  • Gaining access to clinical patient data at discharge via an HIE has the potential to reduce 30-day same-cause hospital readmissions and furthermore avert the potential costs of readmissions.

For the complete analysis and discussion, recommend reading “The Potential for Community-Based Health Information Exchange Systems to Reduce Hospital Readmissions”.   Information on the development and status of the Rochester RHIO on website.