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- Title
Impact of event notification services on timely follow-up and rehospitalization among primary care patients at two Veterans Affairs Medical Centers.
- Authors
Dixon, Brian E; Judon, Kimberly M; Schwartzkopf, Ashley L; Guerrero, Vivian M; Koufacos, Nicholas S; May, Justine; Schubert, Cathy C; Boockvar, Kenneth S
- Abstract
<bold>Objective: </bold>To examine the effectiveness of event notification service (ENS) alerts on health care delivery processes and outcomes for older adults.<bold>Materials and Methods: </bold>We deployed ENS alerts in 2 Veterans Affairs (VA) medical centers using regional health information exchange (HIE) networks from March 2016 to December 2019. Alerts targeted VA-based primary care teams when older patients (aged 65+ years) were hospitalized or attended emergency departments (ED) outside the VA system. We employed a concurrent cohort study to compare postdischarge outcomes between patients whose providers received ENS alerts and those that did not (usual care). Outcome measures included: timely follow-up postdischarge (actual phone call within 7 days or an in-person primary care visit within 30 days) and all-cause inpatient or ED readmission within 30 days. Generalized linear mixed models, accounting for clustering by primary care team, were used to compare outcomes between groups.<bold>Results: </bold>Compared to usual care, veterans whose primary care team received notification of non-VA acute care encounters were 4 times more likely to have phone contact within 7 days (AOR = 4.10, P < .001) and 2 times more likely to have an in-person visit within 30 days (AOR = 1.98, P = .007). There were no significant differences between groups in hospital or ED utilization within 30 days of index discharge (P = .057).<bold>Discussion: </bold>ENS was associated with increased timely follow-up following non-VA acute care events, but there was no associated change in 30-day readmission rates. Optimization of ENS processes may be required to scale use and impact across health systems.<bold>Conclusion: </bold>Given the importance of ENS to the VA and other health systems, this study provides guidance for future research on ENS for improving care coordination and population outcomes.<bold>Trial Registration: </bold>ClinicalTrials.gov NCT02689076. "Regional Data Exchange to Improve Care for Veterans After Non-VA Hospitalization." Registered February 23, 2016.
- Subjects
UNITED States; PRIMARY care; MEDICAL care; HEALTH information exchanges; PATIENT care; RATINGS of hospitals; PATIENT readmissions; MEDICAL centers; HOSPITALS; PATIENT aftercare; VETERANS' hospitals; RESEARCH; RESEARCH methodology; EVALUATION research; PRIMARY health care; COMPARATIVE studies; RANDOMIZED controlled trials; RESEARCH funding; VETERANS; STATISTICAL sampling; DISCHARGE planning; LONGITUDINAL method; UNITED States. Dept. of Veterans Affairs
- Publication
Journal of the American Medical Informatics Association, 2021, Vol 28, Issue 12, p2593
- ISSN
1067-5027
- Publication type
journal article
- DOI
10.1093/jamia/ocab189