Health information exchange between hospital and skilled nursing facilities not associated with lower readmissions

Health Serv Res. 2019 Dec;54(6):1335-1345. doi: 10.1111/1475-6773.13210. Epub 2019 Oct 10.

Abstract

Objective: To assess whether an electronic health record (EHR) portal to enable health information exchange (HIE) between a hospital and three skilled nursing facilities (SNFs) reduced likelihood of patient readmission.

Setting/data: Secondary data; all discharges from a large academic medical center to SNFs between July 2013 and March 2017, combined with portal usage records from SNFs with HIE access.

Design: We use difference-in-differences to determine whether portal implementation reduced likelihood of readmission over time for patients discharged to HIE-enabled SNFs, relative to those discharged to nonenabled facilities. Additional descriptive analyses of audit log data characterize portal use within enabled facilities.

Data collection: Encounter-level clinical EHR data were merged with EHR audit log data that captured portal usage in the timeframe associated with a patient transition from hospital to SNF.

Principal findings: Declines in likelihood of 30-day readmission were not significantly different for patients in HIE-enabled vs control SNFs (diff-in-diff = 0.022; P = .431). We observe similar null effects with shorter readmission windows. The portal was used for 46 percent of discharges, with significant usage pattern variation within/across facilities.

Conclusions: Implementation of a hospital-SNF EHR portal did not reduce readmissions from enabled SNFs. Emergent HIE use cases need to be better defined and leveraged for design and implementation that generates value in the context of postacute transitions.

Keywords: care transitions; electronic health records; health information exchange; postacute care.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Continuity of Patient Care / statistics & numerical data*
  • Electronic Health Records / statistics & numerical data*
  • Female
  • Health Information Exchange / statistics & numerical data*
  • Hospitalization / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Patient Discharge / statistics & numerical data*
  • Patient Readmission / statistics & numerical data*
  • Patient Transfer / statistics & numerical data*
  • Skilled Nursing Facilities / statistics & numerical data*
  • United States