Showing Health Information Value in a Community Network

NCT ID: NCT00365885

Last Updated: 2014-07-11

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 20108 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2006-08-31
• Study Completion Date: 2008-08-31

Brief Summary

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.

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.

Conditions

Clinical Decision Support; Medical Informatics Interventions; Population Health Management; Quality of Healthcare

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: FACTORIAL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

1

electronic mail notifications to care managers about sentinel health events

Group Type: EXPERIMENTAL

Computer-based clinical decision support.

Intervention Type: OTHER

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

2

feedback reports with notifications to clinic managers about sentinel health events

Group Type: EXPERIMENTAL

Computer-based clinical decision support.

Intervention Type: OTHER

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

3

letters to patients with notifications about sentinel health events

Group Type: EXPERIMENTAL

Computer-based clinical decision support.

Intervention Type: OTHER

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

4

electronic mail notifications to care managers about sentinel health events -- generated but withheld

Group Type: NO_INTERVENTION

No interventions assigned to this group

5

feedback reports with notifications to clinic managers about sentinel health events -- generated but withheld

Group Type: NO_INTERVENTION

No interventions assigned to this group

6

letters to patients with notifications about sentinel health events -- generated but withheld

Group Type: NO_INTERVENTION

No interventions assigned to this group

Interventions

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

Intervention Type: OTHER

Other Intervention Names

Decision support engine is called SEBASTIAN

Eligibility Criteria

Inclusion Criteria

• Enrollment in the Community Care of North Carolina Medicaid program in Durham County North Carolina

Exclusion Criteria

-

• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Duke University

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

David F Lobach, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Duke University

Locations

Duke University Medical Center

Durham, North Carolina, United States

Countries

United States

References

Eisenstein EL, Anstrom KJ, Macri JM, Crosslin DR, Johnson FS, Kawamoto K, Lobach DF. Assessing the potential economic value of health information technology interventions in a community-based health network. AMIA Annu Symp Proc. 2005;2005:221-5.

Reference Type: BACKGROUND

PMID: 16779034 (View on PubMed)

Other Identifiers

R01HS015057

Identifier Type: AHRQ

Identifier Source: secondary_id

View Link

Pro00006833

Identifier Type: -

Identifier Source: org_study_id