Asthma, Cardiovascular Diseases, Diabetes Mellitus, Heart Failure, Osteoporosis
Conditions
Brief summary
Three out of four Veterans receive a portion of their care from non-VA providers. On April 9, 2009, President Barack Obama directed the Department of Veterans Affairs and the Department of Defense to create the Virtual Lifetime Electronic Record (VLER). On August 2010, Secretary of Veterans Affairs Eric K. Shinseki visited Indianapolis, and after visiting with leaders from the VA Health Services Research & Development (HSR&D) Center of Excellence and the Regenstrief Institute, he made the following public comments regarding the latest partnership between the two institutions: This new technology allows safer, more secure, and private access to electronic health information which, in turn, enhances our ability to continue providing Veterans with the quality care that they have earned. This new technology refers to the VLER HEALTH program that the Indianapolis VA is now implementing in partnership with the Regenstrief Institute and Indiana Health Information Exchange (IHIE). This VA-IHIE demonstration project is intended to create the capacity for VA institutions to exchange health information with community partners. Investigators from the VA HSR&D Center on Implementing Evidence-Based Practice are active collaborators in building and implementing this program. The VA-IHIE program provides the bi-directional exchange of health information between VA and non-VA providers. Based on our pilot study of linked VA-IHIE data, investigators are conducting an evaluation of the impact of the VA-IHIE demonstration project upon health care quality and cost of Veterans by taking advantage of the initiation of the implementation as a natural experiment.
Detailed description
This study will perform a pre-post evaluation of the VA-IHIE implementation, with a concurrent control group, among Veterans seen at the Indianapolis VA. Data on care received by Veterans will be obtained for one year before, and one year after, VA-IHIE enrollment. Patients will be recruited into the VA-IHIE program in a rolling manner over the course of a year, and thus will have different calendar intervals of follow-up. For purposes of evaluation, investigators will approach the VA-IHIE implementation as a patient-directed intervention given that additional information available from the exchange is available only on a patient-by-patient basis, i.e., a provider cannot use exchange information available for one patient in the care of another. Although the VA-IHIE program will be implemented at the site level, patients will be enrolled individually.
Interventions
OTHERActive Health Information Exchange
Patients selected to share data between the VA & external healthcare agencies.
OTHERNon-Active Health Information exchange
Patients not selecting to share data
Sponsors
Regenstrief Institute, Inc.
VA Office of Research and Development
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* Veteran's receiving care at the Indianapolis VAMC at least one year prior and one year post VA-IHIE enrollment * Veteran's receiving care from a facility other than the Indianapolis VAMC one year prior and one year post VA-IHIE enrollment
Exclusion criteria
None
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Understanding Utilization of Healthcare Procedures by Veterans According to Source of Data | 2 years | Determining rates of usage of healthcare by veterans by source of data. This will clue us into any differences in utilization patterns between groups. |
| Effect of Health Information Exchange on Cost | 2 Years | Before after analysis of the presence of health information exchange on costs within the VA healthcare system; Measure is cost, unadjusted, in dollars for the year post enrollment in the health information exchange |
| Health Care Quality: Affect of HIE on LDL Levels of Participants. | 3 years | This study will measure the impact of HIE upon health care quality the underuse of ambulatory care services for diabetics. Measurements of underuse before and after implementation will detect improvements in the quality of care. To measure underuse, the study employs a measurement set that is sensitive to the potential effects and feasible for electronic data capture. In this specific instance, we expect the LDL levels to reflect lower numbers among diabetics due to greater health management via information sharing. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Health Care Quality: Care Sensitive Admissions | 3 years | This study will use the Agency for Healthcare Research and Quality's (AHRQ) Prevention Quality Indicators (PQI) to calculate the outcome measure. The PQIs are a set of measures used with hospital inpatient data to identify ambulatory care sensitive conditions. The PQIs consist of 14 conditions. The study will adopt 12 that are commonly used for adult patients: angina, asthma, bacterial pneumonia, chronic obstructive pulmonary disease, congestive heart failure, dehydration, diabetes long-term complications, diabetes short-term complications, diabetes uncontrolled, hypertension, lower-limb amputation among diabetes patients, and urinary infection. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Controls in Study (Not Enrolled in Health Care Exchange) Patients in this arm will represent Veterans seen at the Indianapolis VAMC for whom information exchange has not been activated. | 50,446 |
| Enrolled in HIE Patients in this arm will represent Veterans seen at the Indianapolis VAMC for whom information exchange has been activated by the patient choosing to opt-in. | 6,627 |
| Total | 57,073 |
Baseline characteristics
| Characteristic | Controls in Study (Not Enrolled in Health Care Exchange) | Enrolled in HIE | Total |
|---|---|---|---|
| Age, Continuous | 60.74 years STANDARD_DEVIATION 15.77 | 62.17 years STANDARD_DEVIATION 13.98 | 60.91 years STANDARD_DEVIATION 15.58 |
| Charlson Score | .66 units on a scale STANDARD_DEVIATION 1.42 | 1.25 units on a scale STANDARD_DEVIATION 1.92 | .73 units on a scale STANDARD_DEVIATION 1.5 |
| Region of Enrollment United States | 50446 Participants | 6627 Participants | 57073 Participants |
| Sex: Female, Male Female | 3607 Participants | 514 Participants | 4121 Participants |
| Sex: Female, Male Male | 46839 Participants | 6113 Participants | 52952 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 50,446 | 0 / 6,627 |
| serious Total, serious adverse events | 0 / 50,446 | 0 / 6,627 |
Outcome results
Primary
Effect of Health Information Exchange on Cost
Before after analysis of the presence of health information exchange on costs within the VA healthcare system; Measure is cost, unadjusted, in dollars for the year post enrollment in the health information exchange
Time frame: 2 Years
Population: 5269 individuals were excluded due to lacking cost information.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Controls in Study (Not Enrolled in Health Care Exchange) | Effect of Health Information Exchange on Cost | 6,529 $ per year unadjusted total VA cost |
| Enrolled in HIE | Effect of Health Information Exchange on Cost | 9,915 $ per year unadjusted total VA cost |
Primary
Health Care Quality: Affect of HIE on LDL Levels of Participants.
This study will measure the impact of HIE upon health care quality the underuse of ambulatory care services for diabetics. Measurements of underuse before and after implementation will detect improvements in the quality of care. To measure underuse, the study employs a measurement set that is sensitive to the potential effects and feasible for electronic data capture. In this specific instance, we expect the LDL levels to reflect lower numbers among diabetics due to greater health management via information sharing.
Time frame: 3 years
Population: These are diabetics within the cohort defined as being diagnosed, alive, and being aged 18-75. Specifically looking at LDL
| Arm | Measure | Value (LEAST_SQUARES_MEAN) |
|---|---|---|
| Controls in Study (Not Enrolled in Health Care Exchange) | Health Care Quality: Affect of HIE on LDL Levels of Participants. | 86.308 mg/dL of LDL |
| Enrolled in HIE | Health Care Quality: Affect of HIE on LDL Levels of Participants. | 85.263 mg/dL of LDL |
| Controls Post Intervention | Health Care Quality: Affect of HIE on LDL Levels of Participants. | 83.957 mg/dL of LDL |
| Enrolled Post Intervention | Health Care Quality: Affect of HIE on LDL Levels of Participants. | 82.640 mg/dL of LDL |
Primary
Understanding Utilization of Healthcare Procedures by Veterans According to Source of Data
Determining rates of usage of healthcare by veterans by source of data. This will clue us into any differences in utilization patterns between groups.
Time frame: 2 years
Population: Veterans divided into enrolled and non-enrolled in HIE groups
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Controls in Study (Not Enrolled in Health Care Exchange) | Understanding Utilization of Healthcare Procedures by Veterans According to Source of Data | VA Data Only | 41982 participants |
| Controls in Study (Not Enrolled in Health Care Exchange) | Understanding Utilization of Healthcare Procedures by Veterans According to Source of Data | Data in Both Sources | 8358 participants |
| Controls in Study (Not Enrolled in Health Care Exchange) | Understanding Utilization of Healthcare Procedures by Veterans According to Source of Data | Data only in Outside Source | 20 participants |
| Controls in Study (Not Enrolled in Health Care Exchange) | Understanding Utilization of Healthcare Procedures by Veterans According to Source of Data | No Data | 86 participants |
| Enrolled in HIE | Understanding Utilization of Healthcare Procedures by Veterans According to Source of Data | No Data | 20 participants |
| Enrolled in HIE | Understanding Utilization of Healthcare Procedures by Veterans According to Source of Data | VA Data Only | 5073 participants |
| Enrolled in HIE | Understanding Utilization of Healthcare Procedures by Veterans According to Source of Data | Data only in Outside Source | 37 participants |
| Enrolled in HIE | Understanding Utilization of Healthcare Procedures by Veterans According to Source of Data | Data in Both Sources | 1497 participants |
Secondary
Health Care Quality: Care Sensitive Admissions
This study will use the Agency for Healthcare Research and Quality's (AHRQ) Prevention Quality Indicators (PQI) to calculate the outcome measure. The PQIs are a set of measures used with hospital inpatient data to identify ambulatory care sensitive conditions. The PQIs consist of 14 conditions. The study will adopt 12 that are commonly used for adult patients: angina, asthma, bacterial pneumonia, chronic obstructive pulmonary disease, congestive heart failure, dehydration, diabetes long-term complications, diabetes short-term complications, diabetes uncontrolled, hypertension, lower-limb amputation among diabetes patients, and urinary infection.
Time frame: 3 years
Population: This analysis looked specifically at hospitalizations within a cohort of diabetes patients (a subset of the whole).
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Controls in Study (Not Enrolled in Health Care Exchange) | Health Care Quality: Care Sensitive Admissions | 2083 ACS Hospitalizations per 100k patients |
| Enrolled in HIE | Health Care Quality: Care Sensitive Admissions | 3229 ACS Hospitalizations per 100k patients |
| Controls Post Intervention | Health Care Quality: Care Sensitive Admissions | 2194 ACS Hospitalizations per 100k patients |
| Enrolled Post Intervention | Health Care Quality: Care Sensitive Admissions | 3350 ACS Hospitalizations per 100k patients |