Impact of event notification services on timely follow-up and rehospitalization among primary care patients at two Veterans Affairs Medical Centers
Abstract Objective To examine the effectiveness of event notification service (ENS) alerts on health care delivery processes and outcomes for older adults. Materials and methods We deployed ENS alerts in 2 Veterans Affairs (VA) medical centers using regional health information exchange (HIE) network...
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| Veröffentlicht in: | Journal of the American Medical Informatics Association : JAMIA 2021-11, Vol.28 (12), p.2593-2600 |
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| creator | Dixon, Brian E Judon, Kimberly M Schwartzkopf, Ashley L Guerrero, Vivian M Koufacos, Nicholas S May, Justine Schubert, Cathy C Boockvar, Kenneth S |
| description | Abstract
Objective
To examine the effectiveness of event notification service (ENS) alerts on health care delivery processes and outcomes for older adults.
Materials and methods
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.
Results
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 |
| doi_str_mv | 10.1093/jamia/ocab189 |
| format | Article |
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Objective
To examine the effectiveness of event notification service (ENS) alerts on health care delivery processes and outcomes for older adults.
Materials and methods
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.
Results
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).
Discussion
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.
Conclusion
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.
Trial Registration
ClinicalTrials.gov NCT02689076. “Regional Data Exchange to Improve Care for Veterans After Non-VA Hospitalization.” Registered February 23, 2016.</description><identifier>ISSN: 1527-974X</identifier><identifier>ISSN: 1067-5027</identifier><identifier>EISSN: 1527-974X</identifier><identifier>DOI: 10.1093/jamia/ocab189</identifier><identifier>PMID: 34597411</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Aftercare ; Aged ; Cohort Studies ; Follow-Up Studies ; Hospitals ; Hospitals, Veterans ; Humans ; Patient Discharge ; Primary Health Care ; Research and Applications ; United States ; United States Department of Veterans Affairs ; Veterans</subject><ispartof>Journal of the American Medical Informatics Association : JAMIA, 2021-11, Vol.28 (12), p.2593-2600</ispartof><rights>Published by Oxford University Press on behalf of the American Medical Informatics Association 2021. This work is written by US Government employees and is in the public domain in the US. 2021</rights><rights>Published by Oxford University Press on behalf of the American Medical Informatics Association 2021. This work is written by US Government employees and is in the public domain in the US.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c420t-67a4a0308925a9ea087d664cd6f07ebabdd517d6e5ebe1b46b98856c5f9533cc3</citedby><cites>FETCH-LOGICAL-c420t-67a4a0308925a9ea087d664cd6f07ebabdd517d6e5ebe1b46b98856c5f9533cc3</cites><orcidid>0000-0002-1121-0607 ; 0000-0003-1165-5558</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8633605/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8633605/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,1578,27903,27904,53768,53770</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34597411$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dixon, Brian E</creatorcontrib><creatorcontrib>Judon, Kimberly M</creatorcontrib><creatorcontrib>Schwartzkopf, Ashley L</creatorcontrib><creatorcontrib>Guerrero, Vivian M</creatorcontrib><creatorcontrib>Koufacos, Nicholas S</creatorcontrib><creatorcontrib>May, Justine</creatorcontrib><creatorcontrib>Schubert, Cathy C</creatorcontrib><creatorcontrib>Boockvar, Kenneth S</creatorcontrib><title>Impact of event notification services on timely follow-up and rehospitalization among primary care patients at two Veterans Affairs Medical Centers</title><title>Journal of the American Medical Informatics Association : JAMIA</title><addtitle>J Am Med Inform Assoc</addtitle><description>Abstract
Objective
To examine the effectiveness of event notification service (ENS) alerts on health care delivery processes and outcomes for older adults.
Materials and methods
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.
Results
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).
Discussion
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.
Conclusion
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.
Trial Registration
ClinicalTrials.gov NCT02689076. “Regional Data Exchange to Improve Care for Veterans After Non-VA Hospitalization.” Registered February 23, 2016.</description><subject>Aftercare</subject><subject>Aged</subject><subject>Cohort Studies</subject><subject>Follow-Up Studies</subject><subject>Hospitals</subject><subject>Hospitals, Veterans</subject><subject>Humans</subject><subject>Patient Discharge</subject><subject>Primary Health Care</subject><subject>Research and Applications</subject><subject>United States</subject><subject>United States Department of Veterans Affairs</subject><subject>Veterans</subject><issn>1527-974X</issn><issn>1067-5027</issn><issn>1527-974X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkc1u1TAQhS1ERUthyRZ5ySbUjmMn2SBVV_xUKmLTVuysiTNuXTlxsJ1bldfghTHcSykrVjOaOfOdkQ4hrzh7y1kvTm5hcnASDAy865-QIy7rturb5uvTR_0heZ7SLWNc1UI-I4eikWXM-RH5cTYtYDINluIW50znkJ11BrILM00Yt85goqXPbkJ_T23wPtxV60JhHmnEm5AWl8G777sTmMJ8TZfoJoj31EBEupRNQScKmea7QK8wY4Q50VNrwcVEP-NYHD3dFBXG9IIcWPAJX-7rMbn88P5i86k6__LxbHN6XpmmZrlSLTTABOv6WkKPwLp2VKoxo7KsxQGGcZS8jFDigHxo1NB3nVRG2l4KYYw4Ju923GUdJhxNcY_g9f53HcDpfzezu9HXYas7JYRisgDe7AExfFsxZT25ZNB7mDGsSdey7VrV8IYVabWTmhhSimgfbDjTv4LUv4PU-yCL_vXj3x7Uf5L76x3W5T-sn2uOrtQ</recordid><startdate>20211125</startdate><enddate>20211125</enddate><creator>Dixon, Brian E</creator><creator>Judon, Kimberly M</creator><creator>Schwartzkopf, Ashley L</creator><creator>Guerrero, Vivian M</creator><creator>Koufacos, Nicholas S</creator><creator>May, Justine</creator><creator>Schubert, Cathy C</creator><creator>Boockvar, Kenneth S</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-1121-0607</orcidid><orcidid>https://orcid.org/0000-0003-1165-5558</orcidid></search><sort><creationdate>20211125</creationdate><title>Impact of event notification services on timely follow-up and rehospitalization among primary care patients at two Veterans Affairs Medical Centers</title><author>Dixon, Brian E ; Judon, Kimberly M ; Schwartzkopf, Ashley L ; Guerrero, Vivian M ; Koufacos, Nicholas S ; May, Justine ; Schubert, Cathy C ; Boockvar, Kenneth S</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c420t-67a4a0308925a9ea087d664cd6f07ebabdd517d6e5ebe1b46b98856c5f9533cc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Aftercare</topic><topic>Aged</topic><topic>Cohort Studies</topic><topic>Follow-Up Studies</topic><topic>Hospitals</topic><topic>Hospitals, Veterans</topic><topic>Humans</topic><topic>Patient Discharge</topic><topic>Primary Health Care</topic><topic>Research and Applications</topic><topic>United States</topic><topic>United States Department of Veterans Affairs</topic><topic>Veterans</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dixon, Brian E</creatorcontrib><creatorcontrib>Judon, Kimberly M</creatorcontrib><creatorcontrib>Schwartzkopf, Ashley L</creatorcontrib><creatorcontrib>Guerrero, Vivian M</creatorcontrib><creatorcontrib>Koufacos, Nicholas S</creatorcontrib><creatorcontrib>May, Justine</creatorcontrib><creatorcontrib>Schubert, Cathy C</creatorcontrib><creatorcontrib>Boockvar, Kenneth S</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of the American Medical Informatics Association : JAMIA</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dixon, Brian E</au><au>Judon, Kimberly M</au><au>Schwartzkopf, Ashley L</au><au>Guerrero, Vivian M</au><au>Koufacos, Nicholas S</au><au>May, Justine</au><au>Schubert, Cathy C</au><au>Boockvar, Kenneth S</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of event notification services on timely follow-up and rehospitalization among primary care patients at two Veterans Affairs Medical Centers</atitle><jtitle>Journal of the American Medical Informatics Association : JAMIA</jtitle><addtitle>J Am Med Inform Assoc</addtitle><date>2021-11-25</date><risdate>2021</risdate><volume>28</volume><issue>12</issue><spage>2593</spage><epage>2600</epage><pages>2593-2600</pages><issn>1527-974X</issn><issn>1067-5027</issn><eissn>1527-974X</eissn><abstract>Abstract
Objective
To examine the effectiveness of event notification service (ENS) alerts on health care delivery processes and outcomes for older adults.
Materials and methods
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.
Results
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).
Discussion
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.
Conclusion
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.
Trial Registration
ClinicalTrials.gov NCT02689076. “Regional Data Exchange to Improve Care for Veterans After Non-VA Hospitalization.” Registered February 23, 2016.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>34597411</pmid><doi>10.1093/jamia/ocab189</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-1121-0607</orcidid><orcidid>https://orcid.org/0000-0003-1165-5558</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of the American Medical Informatics Association : JAMIA, 2021-11, Vol.28 (12), p.2593-2600 |
| issn | 1527-974X 1067-5027 1527-974X |
| language | eng |
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| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central |
| subjects | Aftercare Aged Cohort Studies Follow-Up Studies Hospitals Hospitals, Veterans Humans Patient Discharge Primary Health Care Research and Applications United States United States Department of Veterans Affairs Veterans |
| title | Impact of event notification services on timely follow-up and rehospitalization among primary care patients at two Veterans Affairs Medical Centers |
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