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Zhang J, Ashrafian H, Delaney B, Darzi A. Impact of primary to secondary care data sharing on care quality in NHS England hospitals. NPJ Digit Med 2023; 6:144. [PMID: 37580595 PMCID: PMC10425337 DOI: 10.1038/s41746-023-00891-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 08/01/2023] [Indexed: 08/16/2023] Open
Abstract
Health information exchange (HIE) is seen as a key component of effective care but remains poorly evidenced at a health system level. In the UK National Health Service (NHS), the ability to share primary care data with secondary care clinicians is a focus of continued digital investment. In this study, we report the evolution of interoperable technology across a period of rapid digital transformation in NHS England from 2015 to 2019, and test association of primary to secondary care data-sharing capabilities with clinical care quality indicators across all acute secondary care providers (n = 135 NHS Trusts). In multivariable analyses, data-sharing capabilities are associated with reduction in patients breaching an Accident & Emergency (A&E) 4-h decision time threshold, and better patient-reported experience of acute hospital care quality. Using synthetic control analyses, we estimate mean 2.271% (STD+/-3.371) absolute reduction in A&E 4-h decision time breach, 12 months following introduction of data-sharing capabilities. Our findings support current digital transformation programmes for developing regional HIE networks but highlight the need to focus on implementation factors in addition to technological procurement.
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Affiliation(s)
- Joe Zhang
- Institute of Global Health Innovation, Imperial College London, London, UK.
- Department of Critical Care Medicine, Guy's and St Thomas' Hospital, London, UK.
| | - Hutan Ashrafian
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Brendan Delaney
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Ara Darzi
- Institute of Global Health Innovation, Imperial College London, London, UK
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2
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Nakayama M, Inoue R, Miyata S, Shimizu H. Health Information Exchange between Specialists and General Practitioners Benefits Rural Patients. Appl Clin Inform 2021; 12:564-572. [PMID: 34107543 DOI: 10.1055/s-0041-1731287] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Health information exchange (HIE) may improve diagnostic accuracy, treatment efficacy, and safety by providing treating physicians with expert advice. However, most previous studies on HIE have been observational in nature. OBJECTIVES To examine whether collaboration between specialists and general practitioners (GPs) in rural areas via HIE can improve outcomes among patients at low-to-moderate risk of cardiovascular disease, kidney disease, and stroke. METHODS In this randomized controlled trial, the Miyagi Medical and Welfare Information Network was used for HIE. We evaluated the clinical data of 1,092 patients aged ≥65 years living in the rural areas of the Miyagi Prefecture and receiving care from GPs only. High-risk patients were immediately referred to specialists, whereas low-to-moderate risk patients were randomly assigned to an intervention group in which GPs were advised by specialists through HIE (n = 518, 38% male, mean age = 76 ± 7 years) or a control group in which GPs received no advice by specialists (n = 521, 39% male, mean age = 75 ± 7 years). RESULTS In the intention-to-treat analysis, all-cause mortality and cumulative incidence of serious adverse events (e.g., hospital admission or unexpected referral to specialists) did not differ between the groups. However, per-protocol analysis controlling for GP adherence with specialist recommendations revealed significantly reduced all-cause mortality (p = 0.04) and cumulative serious adverse event incidence (p = 0.04) in the intervention group compared with the control group. CONCLUSION HIE systems may improve outcomes among low-to-moderate risk patients by promoting greater collaboration between specialists and GPs, particularly in rural areas with few local specialists.
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Affiliation(s)
- Masaharu Nakayama
- Department of Medical Informatics, Tohoku University Graduate School of Medicine, Sendai, Japan.,Medical Information Technology Center, Tohoku University Hospital, Sendai, Japan
| | - Ryusuke Inoue
- Medical Information Technology Center, Tohoku University Hospital, Sendai, Japan
| | - Satoshi Miyata
- Department of Biostatistics, Teikyo University Graduate School of Public Health, Tokyo, Japan
| | - Hiroaki Shimizu
- Department of Neurosurgery, Akita University Hospital, Akita, Japan
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3
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Deschamps J, Gilbertson J, Straube S, Dong K, MacMaster FP, Korownyk C, Montgomery L, Mahaffey R, Downar J, Clarke H, Muscedere J, Rittenbach K, Featherstone R, Sebastianski M, Vandermeer B, Lynam D, Magnussen R, Bagshaw SM, Rewa OG. Association between supportive interventions and healthcare utilization and outcomes in patients on long-term prescribed opioid therapy presenting to acute healthcare settings: a systematic review and meta-analysis. BMC Emerg Med 2021; 21:17. [PMID: 33514325 PMCID: PMC7845034 DOI: 10.1186/s12873-020-00398-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 12/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Long-term prescription of opioids by healthcare professionals has been linked to poor individual patient outcomes and high resource utilization. Supportive strategies in this population regarding acute healthcare settings may have substantial impact. METHODS We performed a systematic review and meta-analysis of primary studies. The studies were included according to the following criteria: 1) age 18 and older; 2) long-term prescribed opioid therapy; 3) acute healthcare setting presentation from a complication of opioid therapy; 4) evaluating a supportive strategy; 5) comparing the effectiveness of different interventions; 6) addressing patient or healthcare related outcomes. We performed a qualitative analysis of supportive strategies identified. We pooled patient and system related outcome data for each supportive strategy. RESULTS A total of 5664 studies were screened and 19 studies were included. A total of 9 broad categories of supportive strategies were identified. Meta-analysis was performed for the "supports for patients in pain" supportive strategy on two system-related outcomes using a ratio of means. The number of emergency department (ED) visits were significantly reduced for cohort studies (n = 6, 0.36, 95% CI [0.20-0.62], I2 = 87%) and randomized controlled trials (RCTs) (n = 3, 0.71, 95% CI [0.61-0.82], I2 = 0%). The number of opioid prescriptions at ED discharge was significantly reduced for RCTs (n = 3, 0.34, 95% CI [0.14-0.82], I2 = 78%). CONCLUSION For patients presenting to acute healthcare settings with complications related to long-term opioid therapy, the intervention with the most robust data is "supports for patients in pain".
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Affiliation(s)
- Jean Deschamps
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 8440 112 St. NW, Critical Care Medicine 2-124E Clinical Sciences Building, Edmonton, Alberta, T6G 2B7, Canada.
| | - James Gilbertson
- School of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Sebastian Straube
- Division of Preventive Medicine, Department of Medicine, University of Alberta, 5-30 University Terrace, 8303 - 112 St NW, Edmonton, Alberta, T6G 2T4, Canada
| | - Kathryn Dong
- Department of Emergency Medicine, University of Alberta, 2J2.00 WC Mackenzie Health Sciences Centre, 8440 112 St NW, Edmonton, Alberta, T6G 2R7, Canada
| | - Frank P MacMaster
- Departments of Psychiatry and Pediatrics, University of Calgary, Strategic Clinical Network for Addictions and Mental Health 2888 Shaganappi Trail NW Calgary, Calgary, Alberta, T3B 6A8, Canada
| | - Christina Korownyk
- Department of Family Medicine, University of Alberta, Suite 205 College Plaza, 8215 112 St NW, Edmonton, Alberta, T6G 2C8, Canada
| | - Lori Montgomery
- Department of Family Medicine, Calgary Chronic Pain Center 1820 Richmond Road SW Calgary, Calgary, Alberta, T2T 5C7, Canada
| | - Ryan Mahaffey
- Department of Anesthesia, University of Ottawa, Ottawa, Ontario, Canada
| | - James Downar
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Hance Clarke
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Ottawa, Ontario, Canada
- Transitional Pain Program, Toronto General Hospital, University Health Network, Ottawa, Ontario, Canada
| | - John Muscedere
- Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
| | - Katherine Rittenbach
- Addiction & Mental Health Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
- Department of Psychiatry, University of Calgary, Calgary, Canada
| | - Robin Featherstone
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Alberta SPOR SUPPORT Unit KT Platform, 4-486D Edmonton Clinical Health Academy, 11405 - 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Meghan Sebastianski
- Knowledge Translation Platform, Alberta SPOR SUPPORT Unit Department of Pediatrics, University of Alberta, 362-B Heritage Medical Research Centre (HMRC), Edmonton, Canada
| | - Ben Vandermeer
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Alberta SPOR SUPPORT Unit KT Platform, 4-486D Edmonton Clinical Health Academy, 11405 - 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Deborah Lynam
- Primary Health Care Information Network, Edmonton, Alberta, Canada
| | - Ryan Magnussen
- Critical Care Strategic Clinical Network, Foothills Medical Centre, ICU Administration - Ground Floor, McCaig Tower, 3134 Hospital Drive, Calgary, Alberta, T2N 2T9, Canada
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 8440 112 St. NW, Critical Care Medicine 2-124E Clinical Sciences Building, Edmonton, Alberta, T6G 2B7, Canada
| | - Oleksa G Rewa
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 8440 112 St. NW, Critical Care Medicine 2-124E Clinical Sciences Building, Edmonton, Alberta, T6G 2B7, Canada
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Wong CK, O'Rielly CM, Teitge BD, Sutherland RL, Farquharson S, Ghosh M, Robertson HL, Lang E. The Characteristics and Effectiveness of Interventions for Frequent Emergency Department Utilizing Patients With Chronic Noncancer Pain: A Systematic Review. Acad Emerg Med 2020; 27:742-752. [PMID: 32030836 DOI: 10.1111/acem.13934] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/30/2020] [Accepted: 02/05/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with chronic noncancer pain (CNCP) present unique challenges to emergency department (ED) care providers and administrators. Their conditions lead to frequent ED visits for pain relief and symptom management and are often poorly addressed with costly, low-yield care. A systematic review has not been performed to inform the management of frequent ED utilizing patients with CNCP. Therefore, we synthesized the available evidence on interventional strategies to improve care-associated outcomes for this patient group. METHODS We searched Medline, EMBASE, CINAHL, CENTRAL, SCOPUS, and Web of Science from database inception to June 2018 for eligible interventional studies aimed at reducing frequent ED utilization among adult patients with CNCP. Articles were assessed in duplicate in accordance with methodologic recommendations from the Cochrane Handbook for Systematic Reviews of Interventions. Outcomes of interest were the frequency of subsequent ED visits, type and amount of opioids administered in the ED and prescribed at discharge, and costs. Methodologic quality was assessed using the Cochrane Risk of Bias in Non-Randomized Studies of Interventions and Risk of Bias tools for nonrandomized and randomized studies, respectively. RESULTS Thirteen studies including 1,679 patients met the inclusion criteria. Identified interventions implemented pain policies (n = 4), individualized care plans (n = 5), ED care coordination (n = 2), chronic pain management pathways (n = 1), and behavioral health interventions (n = 1). All of the studies reported a decrease in ED visit frequency following their respective interventions. These reductions were especially pronounced in studies whose interventions were focused around individualized care plans and primary care involvement. Interventions implementing opioid restriction and pain management policies were largely successful in reducing the amounts of opioid medications administered and prescribed in the ED. CONCLUSIONS Multifaceted interventions, especially those employing individualized care plans, can successfully reduce subsequent ED visits, ED opioid administration and prescription, and care-associated costs for frequent ED utilizing patients with CNCP.
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Affiliation(s)
- Charles K. Wong
- Department of Emergency Medicine Cumming School of Medicine University of Calgary Calgary AB Canada
| | - Connor M. O'Rielly
- Department of Community Health Sciences Cumming School of Medicine University of Calgary Calgary AB Canada
| | - Braden D. Teitge
- Department of Emergency Medicine Cumming School of Medicine University of Calgary Calgary AB Canada
| | - Robert L. Sutherland
- Department of Community Health Sciences Cumming School of Medicine University of Calgary Calgary AB Canada
| | - Scott Farquharson
- Department of Emergency Medicine Cumming School of Medicine University of Calgary Calgary AB Canada
| | - Monty Ghosh
- Department of General Internal Medicine University of Alberta Edmonton AB Canada
| | | | - Eddy Lang
- Department of Emergency Medicine Cumming School of Medicine University of Calgary Calgary AB Canada
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Kimmel HJ, Brice YN, Trikalinos TA, Sarkar IN, Ranney ML. Real-Time Emergency Department Electronic Notifications Regarding High-Risk Patients: A Systematic Review. Telemed J E Health 2019; 25:604-618. [PMID: 30129886 PMCID: PMC6664825 DOI: 10.1089/tmj.2018.0117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 06/10/2018] [Indexed: 11/13/2022] Open
Abstract
Background: To systematically review evidence on the feasibility and efficacy of real-time electronic notifications about patients at high risk of emergency department (ED) recidivism. Methods: Eight electronic databases were searched for empirical studies of real-time ED-based electronic tools, identifying adult patients at high risk of frequent utilization. Study selection and data extraction were performed independently by two reviewers. Qualitative data synthesis and assessment of strength of evidence were conducted through consensus discussion. Results: Of 2,256 records found through the search, 210 were duplicates, 2,004 were excluded based on abstract review, and 31 were excluded after full text review. The final sample consisted of 10 studies described in 11 articles describing the effect of real-time ED-based electronic notifications for high-risk patients. Three were randomized controlled trials (RCTs). All notifications were based on prespecified markers of risk. Seven studies integrated complex care plans into the electronic health record. Effect on ED use and length of stay (LOS) was mixed: nine studies reported decreased ED use, although results were statistically significant in only three studies; for LOS, one study reported a statistically significant reduction. Impact on cost and financial metrics was promising, with three (of three studies reporting this metric) showing improved organizational financial metrics. Three RCTs reported a reduction in opioid prescriptions. Conclusions: Real-time electronic notifications of ED providers regarding patients at high risk of ED recidivism are feasible. They may help reduce resource utilization and costs. Large knowledge gaps remain regarding patient- and provider-centered outcomes.
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Affiliation(s)
- Hannah J. Kimmel
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island
| | - Yanick N. Brice
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Thomas A. Trikalinos
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Indra Neil Sarkar
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island
- Center for Biomedical Informatics, Brown University, Providence, Rhode Island
| | - Megan L. Ranney
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island
- Emergency Digital Health Innovation Program, Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island
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7
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Menachemi N, Rahurkar S, Harle CA, Vest JR. The benefits of health information exchange: an updated systematic review. J Am Med Inform Assoc 2018; 25:1259-1265. [PMID: 29718258 PMCID: PMC7646861 DOI: 10.1093/jamia/ocy035] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/08/2018] [Accepted: 03/18/2018] [Indexed: 11/14/2022] Open
Abstract
Objective Widespread health information exchange (HIE) is a national objective motivated by the promise of improved care and a reduction in costs. Previous reviews have found little rigorous evidence that HIE positively affects these anticipated benefits. However, early studies of HIE were methodologically limited. The purpose of the current study is to review the recent literature on the impact of HIE. Methods We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to conduct our systematic review. PubMed and Scopus databases were used to identify empirical articles that evaluated HIE in the context of a health care outcome. Results Our search strategy identified 24 articles that included 63 individual analyses. The majority of the studies were from the United States representing 9 states; and about 40% of the included analyses occurred in a handful of HIEs from the state of New York. Seven of the 24 studies used designs suitable for causal inference and all reported some beneficial effect from HIE; none reported adverse effects. Conclusions The current systematic review found that studies with more rigorous designs all reported benefits from HIE. Such benefits include fewer duplicated procedures, reduced imaging, lower costs, and improved patient safety. We also found that studies evaluating community HIEs were more likely to find benefits than studies that evaluated enterprise HIEs or vendor-mediated exchanges. Overall, these finding bode well for the HIEs ability to deliver on anticipated improvements in care delivery and reduction in costs.
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Affiliation(s)
- Nir Menachemi
- Department of Health Policy and Management, Indiana University (IU) Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
| | - Saurabh Rahurkar
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
| | - Christopher A Harle
- Department of Health Policy and Management, Indiana University (IU) Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
| | - Joshua R Vest
- Department of Health Policy and Management, Indiana University (IU) Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
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