A study supported by AHRQ at the Department of Community and Family Medicine, within Duke University Medical Center is looking at ways to take better care of patients with complex healthcare needs. The Center is looking at patients who receive care from multiple providers across disparate care locations and wants to coordinate care for these patients with complex healthcare needs to improve the transition of these patients into the ambulatory care setting.
For this study, the patient’s medical information is being made available to patients, primary care practitioners, and care managers following hospitalizations, emergency department encounters, and specialty clinic evaluations. To be able to exchange information, a regional Health Information Exchange (HIE) network was set up to enable providers to connect with 42,000 Medicaid beneficiaries across traditional institutional boundaries in both rural and urban settings in a six county region in the Northern Piedmont of North Carolina.
This network includes 25 ambulatory care practices, 3 federally qualified health centers, 4 rural health clinics, 3 urgent care facilities, 11 government agencies, 5 hospitals, and 2 cross-disciplinary care management teams. The HIE network has identified 4,608 patients with complex healthcare needs and the program is examining how effectively care transitions can be done between sites.
The study is using a randomized controlled trial with 4600 patients, 309 primary care clinicians, and 31 care management workers. The final objective is to develop a decision support system to provide the necessary information needed when discharging patients, or when patients go to the emergency room, or receive specialty care. The proposed system will be based on an emerging standard to use for decision support and will routinely use available claims and scheduling data.
Another study supported by AHRQ is demonstrating how the Southeast Nebraska Behavioral Health Information Exchange needs to be able to operate between rural and urban providers to improve behavioral health outcomes for patients with chronic mental illnesses. Currently, without electronic communication, behavioral health providers are unable to follow the entire treatment path of patients from mental hospitals, protective custody, or crisis mental health. The project will study the barriers to technology acceptance, the adoption of technology, and the impact of HIEs on clinical outcomes.
Both studies were started in 2008 and are scheduled to finish in 2011.