Showing Health Information Value in a Community Network

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
Duke University
ClinicalTrials.gov Identifier:
NCT00365885
First received: August 16, 2006
Last updated: July 9, 2014
Last verified: December 2012

August 16, 2006
July 9, 2014
August 2006
July 2008   (final data collection date for primary outcome measure)
Emergency department utilization rates and hospitalization rates [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
Emergency department utilization rates and hospitalization rates at 6 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
Complete list of historical versions of study NCT00365885 on ClinicalTrials.gov Archive Site
  • ED encounter rates for low severity conditions [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
  • ED encounter rates for asthma [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
  • ED encounter rates for diabetes [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
  • Hospitalization rates [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
  • Hospitalization rates for asthma (also PQI) [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
  • Hospitalization rates for diabetes (also PQI) [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
  • Glycemic control (hemoglobin A1c) [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
  • Medication contraindications [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
  • HEDIS - Preventive services [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
  • HEDIS - # WCC visits [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
  • AHRQ Prevention Quality Indicators [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
  • HEDIS - Asthma and diabetes [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
  • # of messages triggered for health risks [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
  • # of messages triggered for barriers to care [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
  • Missed appointment rates [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
  • Primary care appointment rates [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
  • F/U rates post-partum [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
  • Patient satisfaction instruments (CHAPS) [ Time Frame: at 6 to 9 months after the intervention has been introduced and then at 3 to 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
  • EuroQoL [ Time Frame: at 6 to 9 months after the intervention has been introduced and then at 3 to 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
  • Provider opinion surveys [ Time Frame: At conclusion of study ] [ Designated as safety issue: No ]
  • Costs of ED utilization for all causes [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
  • Costs of ED use for asthma [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
  • Costs of ED use for diabetes [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
  • Costs of ED use for low severity visits [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
  • Hospitalization costs for all causes [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
  • Hospitalization costs for asthma [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
  • Hospitalization costs for diabetes [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
  • Reimbursement for labs+other ancillary services [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
  • Primary care reimbursement [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
  • ED rates for recurrent ED encounters [ Time Frame: at 9 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced. ] [ Designated as safety issue: No ]
  • The following measures will be assessed at 6 months after the intervention has been introduced and then at 6-month intervals as the intervention is sequentially enhanced.
  • ED encounter rates
  • ED encounter rates for asthma
  • ED encounter rates for diabetes
  • Hospitalization rates
  • Hospitalization rates for asthma (also PQI)
  • Hospitalization rates for diabetes (also PQI)
  • Glycemic control (hemoglobin A1c)
  • Medication contraindications
  • HEDIS – Preventive services
  • HEDIS – # WCC visits
  • AHRQ Prevention Quality Indicators
  • HEDIS – Asthma and diabetes
  • # of messages triggered for health risks
  • # of messages triggered for barriers to care
  • Missed appointment rates
  • Primary care appointment rates
  • F/U rates after ear infection/ED/post-partum
  • Patient satisfaction instruments
  • EuroQoL
  • Provider opinion surveys
  • Costs of ED utilization for all causes
  • Costs of ED use for asthma
  • Costs of ED use for diabetes
  • Costs of ED use for low severity visits
  • Hospitalization costs for all causes
  • Hospitalization costs for asthma
  • Hospitalization costs for diabetes
  • Reimbursement for labs+other ancillary services
  • Primary care reimbursement
Not Provided
Not Provided
 
Showing Health Information Value in a Community Network
Showing Health Information Value in a Community Network

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.

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.

Interventional
Not Provided
Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Factorial Assignment
Masking: Single Blind (Subject)
Primary Purpose: Treatment
  • Clinical Decision Support
  • Medical Informatics Interventions
  • Population Health Management
  • Quality of Healthcare
Other: 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
Other Name: Decision support engine is called SEBASTIAN
  • Experimental: 1
    electronic mail notifications to care managers about sentinel health events
    Intervention: Other: Computer-based clinical decision support.
  • Experimental: 2
    feedback reports with notifications to clinic managers about sentinel health events
    Intervention: Other: Computer-based clinical decision support.
  • Experimental: 3
    letters to patients with notifications about sentinel health events
    Intervention: Other: Computer-based clinical decision support.
  • No Intervention: 4
    electronic mail notifications to care managers about sentinel health events -- generated but withheld
  • No Intervention: 5
    feedback reports with notifications to clinic managers about sentinel health events -- generated but withheld
  • No Intervention: 6
    letters to patients with notifications about sentinel health events -- generated but withheld
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;:221-5.

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Completed
20108
August 2008
July 2008   (final data collection date for primary outcome measure)

Inclusion Criteria:

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

Exclusion Criteria:

-

Both
Not Provided
No
Contact information is only displayed when the study is recruiting subjects
United States
 
NCT00365885
Pro00006833, R01-HS015057
Not Provided
Duke University
Duke University
Not Provided
Principal Investigator: David F Lobach, MD, PhD Duke University
Duke University
December 2012

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP